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LIVING TREE PEDIATRICS PLLC NPI 1396102679


NPI Information

NPI: 1396102679
Provider Name: LIVING TREE PEDIATRICS, PLLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 04D2108081

Address:
2900 SE MEDICAL CENTER PARKWAY
SUITE 370
BENTONVILLE, AR
ZIP 72712
Phone: (479) 282-2966
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LIVING TREE PEDIATRICS, PLLC is a pediatrics in Bentonville, AR. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LIVING TREE PEDIATRICS, PLLC NPI is 1396102679. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2900 SE MEDICAL CENTER PARKWAY
SUITE 370
BENTONVILLE, AR
ZIP 72712
Phone: (479) 282-2966
Fax: (479) 282-2967

The provider's authorized official is Julie Lynette Tate .
The authorized official title is Owner and has the following contact phone number (479) 282-2966.

The CLIA number assigned to this NPI record is 04D2108081 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/18/2016 and was last updated on 4/3/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsE7529ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11396102679OTHERARKANSASCLINIC NPI
2192425001MEDICAIDARKANSAS
31013139666OTHERARKANSASSAVAGE NPI
4191183001MEDICAIDARKANSAS
51578731154OTHERARKANSASNPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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