Provider Demographics
NPI:1124095070
Name:BAPTIST HEALTH
Entity type:Organization
Organization Name:BAPTIST HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-202-2080
Mailing Address - Street 1:9601 BAPTIST HEALTH DR STE 109
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6323
Mailing Address - Country:US
Mailing Address - Phone:501-202-2460
Mailing Address - Fax:501-202-6363
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 109
Practice Address - Street 2:SUITE 109
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6323
Practice Address - Country:US
Practice Address - Phone:501-202-2460
Practice Address - Fax:501-202-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR069113336H0001X, 3336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1993601OtherPK
AR156945716Medicaid
AR100547407Medicaid
AR156962733Medicaid
AR100547407Medicaid