NPIMap

Organization Active NPI

University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • Texarkana, AR
National Provider Identifier
1215935234
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Practice address
3417 U of a Way
Texarkana, AR 71854-1419
Phone
(870) 779-6000
Fax
(870) 779-6093
NPI assigned
Jul 13, 2005
Last updated
Dec 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda D George
Title
Vice Chancellor-Chief Financial Off
Phone
(501) 686-5670

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X AR Primary
Community Health Clinic/Center 261QC1500X NU

Addresses

Primary practice location

3417 U of a Way
Texarkana, AR 71854-1419

Mailing address

3417 U of a Way
Texarkana, AR 71854-1419
Phone (870) 779-6000

Other practice location 1

2600 Saint Michael Dr
Texarkana, TX 75503-2372
Phone (903) 614-1000

Other practice location 2

1000 Pine St
Texarkana, TX 75501-5100
Phone (479) 966-4311

Other identifiers 2

IdentifierTypeStateIssuer
303802002MedicaidAR
092113201MedicaidTX

Other names 1

  • UAMS Southwest Family Practice Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040129001063 AR Part B Supplier - Clinic/Group Practice 4082528955 Receives reassigned benefits from 12 practitioners
Practice locations: Texarkana, AR
O20040513000990 TX Part B Supplier - Clinic/Group Practice 4082528955 Receives reassigned benefits from 9 practitioners
Practice locations: Texarkana, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2105856Uams Southwest Family Medical Clinic3417 U of a Way, Texarkana, AR 71854Provider-performed microscopyDec 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Raymond Bredfeldt MD111 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

3417 U of a Way
Texarkana, AR 71854
Phone (870) 779-6000

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Uams Medical CenterLittle Rock, AR, CCN 040016 Hospital Operational/Managerial Control (100%) Dec 1, 2021
Uams Health - Home HealthSearcy, AR, CCN 047057 Home health agency 5% Or Greater Direct Ownership Interest (49%) Dec 1, 2022

Practitioners & affiliated clinicians

Practitioners 73

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 73

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734307200000",
    "number": "1215935234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3417 U OF A WAY",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541419",
            "telephone_number": "870-779-6000",
            "fax_number": "870-779-6093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 U OF A WAY",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541419",
            "telephone_number": "870-779-6000",
            "fax_number": "870-779-6093"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2600 Saint Michael Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755032372",
            "country_code": "US",
            "telephone_number": "903-614-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Pine St",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755015100",
            "country_code": "US",
            "telephone_number": "479-966-4311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-16",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE CHANCELLOR-CHIEF FINANCIAL OFF",
        "authorized_official_telephone_number": "501-686-5670"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "303802002",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092113201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UAMS Southwest Family Practice Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Texarkana, AR

Sources for this page

Verify at the official NPI Registry.