Basic Information
| Provider Information | |||||||||
| NPI: | 1548530694 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEDBERG ALLERGY AND ASTHMA CENTER, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 S 52ND ST | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727588605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794648887 | ||||||||
| FaxNumber: | 4794649949 | ||||||||
| Practice Location | |||||||||
| Address1: | 1585 E RAIN FOREST RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4793018887 | ||||||||
| FaxNumber: | 4794649949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2012 | ||||||||
| LastUpdateDate: | 01/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | HEDBERG | ||||||||
| AuthorizedOfficialFirstName: | CURTIS | ||||||||
| AuthorizedOfficialMiddleName: | LARS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4794648887 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy |
ID Information
| ID | Type | State | Issuer | Description | 1295820918 | 01 | AR | NPI | OTHER | 1861607368 | 01 | AR | NPI | OTHER | 1790812246 | 01 | KY | NPI | OTHER | 1881623965 | 01 | AR | NPI | OTHER |