Basic Information
| Provider Information | |||||||||
| NPI: | 1417967472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER VALLEY ANESTHESIA ASSOCIATES, P. A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2910 JENNY LIND | ||||||||
| Address2: | BLDG.#12 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729016735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797852555 | ||||||||
| FaxNumber: | 4797853555 | ||||||||
| Practice Location | |||||||||
| Address1: | 2910 JENNY LIND | ||||||||
| Address2: | BLDG.#12 | ||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729016735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797852555 | ||||||||
| FaxNumber: | 4797853555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | ELLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4797852555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MC2019 | AR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.