Provider Demographics
NPI:1992950638
Name:BAPTIST HEALTH MEDICAL CENTER
Entity type:Organization
Organization Name:BAPTIST HEALTH MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENISH
Authorized Official - Suffix:
Authorized Official - Credentials:P-LPE
Authorized Official - Phone:501-450-2690
Mailing Address - Street 1:9601 LILE DR
Mailing Address - Street 2:BEHAVIORAL SERVICES
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-202-7053
Mailing Address - Fax:501-202-7334
Practice Address - Street 1:11401 INTERSTATE 30
Practice Address - Street 2:BEHAVIORAL SERVICES
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7042
Practice Address - Country:US
Practice Address - Phone:501-450-2690
Practice Address - Fax:501-993-7036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08-22 AE-PL273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit