Basic Information
| Provider Information | |||||||||
| NPI: | 1457600405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATCHU | ||||||||
| FirstName: | VERA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8518 GATE HOUSE WAY | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794414000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8518 GATEHOUSE WAY | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729166021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794414000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2012 | ||||||||
| LastUpdateDate: | 03/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E9880 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1457600405 | 05 | MD | MEDICAID |