Basic Information
Provider Information | |||||||||
NPI: | 1760070312 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BH-UAMS ONCOLOGY SERVICES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3401 SPRINGHILL DR STE 130 | ||||||||
Address2: |   | ||||||||
City: | NORTH LITTLE ROCK | ||||||||
State: | AR | ||||||||
PostalCode: | 721172925 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5012961200 | ||||||||
FaxNumber: | 5015265148 | ||||||||
Practice Location | |||||||||
Address1: | 3401 SPRINGHILL DR STE 130 | ||||||||
Address2: |   | ||||||||
City: | NORTH LITTLE ROCK | ||||||||
State: | AR | ||||||||
PostalCode: | 721172925 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5012142460 | ||||||||
FaxNumber: | 5012142461 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/08/2021 | ||||||||
LastUpdateDate: | 09/21/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GEORGE | ||||||||
AuthorizedOfficialFirstName: | AMANDA | ||||||||
AuthorizedOfficialMiddleName: | D | ||||||||
AuthorizedOfficialTitleorPosition: | VICE CHANCELLOR-CHIEF FINANCIAL OFF | ||||||||
AuthorizedOfficialTelephone: | 5016865670 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | BH-UAMS ONCOLOGY SERVICES, LLC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/21/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0203X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Oncology, Radiation |
No ID Information.