Provider Demographics
NPI:1588173231
Name:PREMISE HEALTH OF ARKANSAS MEDICAL P A
Entity type:Organization
Organization Name:PREMISE HEALTH OF ARKANSAS MEDICAL P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOMACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-468-6248
Mailing Address - Street 1:5500 MARYLAND WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7048
Mailing Address - Country:US
Mailing Address - Phone:844-407-7557
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 205
Practice Address - Street 2:HIGHLAND INDUSTRIAL PARK
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-9998
Practice Address - Country:US
Practice Address - Phone:870-574-5700
Practice Address - Fax:870-574-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center