| Baptist Health Specialty Clinic Malvern | |
|
1002 Schneider Dr Ste 103 Malvern AR 72104-4823 | |
| (501) 332-1012 | |
| (501) 332-7074 |
| Full Name | Baptist Health Specialty Clinic Malvern |
|---|---|
| Speciality | Surgery |
| Location | 1002 Schneider Dr Ste 103, Malvern, Arkansas |
| Authorized Official Name and Position | Will Rusher (CEO) |
| Authorized Official Contact | 5018127509 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baptist Health Specialty Clinic Malvern 11001 Executive Center Dr Ste 200 Little Rock AR 72211-4393 Ph: (501) 812-7215 | Baptist Health Specialty Clinic Malvern 1002 Schneider Dr Ste 103 Malvern AR 72104-4823 Ph: (501) 332-1012 |
| NPI Number | 1780015958 |
|---|---|
| Provider Enumeration Date | 12/12/2013 |
| Last Update Date | 04/11/2019 |
| Medicare PECOS PAC ID | 7911802079 |
|---|---|
| Medicare Enrollment ID | O20141031000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780015958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | C-5483 (Arkansas) | Secondary |
| 208600000X | Surgery | N-8012 (Arkansas) | Primary |
| Provider Name | Eliyahu Hemo |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1255627824 PECOS PAC ID: 7517277627 Enrollment ID: I20170819000026 |
| Provider Name | Lea Ann Norton |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1689307795 PECOS PAC ID: 4183008618 Enrollment ID: I20220901002858 |
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