NPIMap

Organization Active NPI

Evergreen Internal Medicine PLLC

  • Primary Care Clinic/Center
  • Little Rock, AR
National Provider Identifier
1801017595
Registry record updated Oct 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
EVERGREEN INTERNAL MEDICINE PLLC
Practice address
1100 N University Ave
Suite 125
Little Rock, AR 72207-6343
Phone
(501) 664-1540
NPI assigned
May 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2009

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

Authorized official

Name
Dr. Robert A Henry, M.D.NPI 1457456808
Title
Managing Member
Phone
(501) 664-1540

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1100 N University Ave
Suite 125
Little Rock, AR 72207-6343

Mailing address

1100 N University Ave
Suite 125
Little Rock, AR 72207-6343
Phone (501) 664-1540

National Provider Directory

National Provider Directory

Locations

1100 N University Ave
Ste 125
Little Rock, AR 72207
Phone (501) 663-0055

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1801017595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N UNIVERSITY AVE",
            "address_2": "SUITE 125",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722076343",
            "telephone_number": "501-664-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N UNIVERSITY AVE",
            "address_2": "SUITE 125",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722076343",
            "telephone_number": "501-664-1540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN INTERNAL MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "501-664-1540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.