| Benny J Green Md Pa | |
|
14309 Cantrell Rd Ste 7 Little Rock AR 72223 | |
| (501) 224-6727 | |
| (501) 224-0674 |
| Full Name | Benny J Green Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 14309 Cantrell Rd, Little Rock, Arkansas |
| Authorized Official Name and Position | Sherry L Morshedi (PRACTICE MANAGER) |
| Authorized Official Contact | 5012246727 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benny J Green Md Pa 14309 Cantrell Rd Ste 7 Little Rock AR 72223 Ph: (501) 224-6727 | Benny J Green Md Pa 14309 Cantrell Rd Ste 7 Little Rock AR 72223 Ph: (501) 224-6727 |
| NPI Number | 1043246168 |
|---|---|
| Provider Enumeration Date | 06/23/2006 |
| Last Update Date | 01/11/2016 |
| Medicare PECOS PAC ID | 8628021508 |
|---|---|
| Medicare Enrollment ID | O20050303000141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043246168 | NPI | - | NPPES |
| CD8533 | Other | RAILROAD MEDICARE | |
| 122497002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Keith D Hough |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295732758 PECOS PAC ID: 8921141003 Enrollment ID: I20100211000713 |
| Provider Name | Benny J Green |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609873983 PECOS PAC ID: 3779536669 Enrollment ID: I20100422000673 |
| Provider Name | Stacy L Graham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245699024 PECOS PAC ID: 4789975442 Enrollment ID: I20160628000732 |
| Provider Name | Rebecca A Camp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013367226 PECOS PAC ID: 3476848524 Enrollment ID: I20160829000734 |
| Provider Name | Amy M Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932754942 PECOS PAC ID: 6406285907 Enrollment ID: I20200403003115 |
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