Organization
ARKANSAS HEALTH GROUP
Active
Other names
Arkansas Vascular
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY JOHNSON (PMA)
(501) 812-7514
Entity
Organization
Contact information
Practice address
9601 LILE DR STE 250, MEDICAL TOWERS 1, LITTLE ROCK, AR 72205-6355
(501) 227-4787
Mailing address
11001 EXECUTIVE CENTER DR, SUITE 200, LITTLE ROCK, AR 72211-4316
(501) 812-7587
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159837002
—
AR
Enumeration date
11/30/2006
Last updated
05/22/2008
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