# UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
- **Other names:** 12th Street Health and Wellness Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1700503745
- **Legal business name:** UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
- **Authorized official:** SUSAN D MOORE (MANAGER)
- **Authorized official phone:** (501) 614-2006

## Contact information

- **Practice address:** 4010 W 12TH ST, LITTLE ROCK, AR 72204-2047
- **Practice address phone:** (501) 614-2492
- **Practice address fax:** (501) 614-2495
- **Mailing address:** 4010 W 12TH ST, LITTLE ROCK, AR 72204-2047
- **Mailing address phone:** (501) 614-2492
- **Mailing address fax:** (501) 614-2495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/20/2022
- **Last updated:** 10/20/2022