Basic Information
| Provider Information | |||||||||
| NPI: | 1245355296 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH ARKANSAS MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | NORTH ARKANSAS ANESTHESIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 432 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726540432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704247070 | ||||||||
| FaxNumber: | 8704246616 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 N WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | HARRISON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726012994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703652000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | NIX | ||||||||
| AuthorizedOfficialFirstName: | LILA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8704247070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 160956002 | 05 | AR | MEDICAID |