MEDICARE: DR. GEORGE HENRY TOMPKINS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E-0883	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E0883	OTHER	AR	AR LICENSE

General Provider Information

NPI Number	:	1164418679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE HENRY TOMPKINS D.O.

Provider Business Mailing Address
First Line	:	400 FAYETTEVILLE RD
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-3921
Country	:	US
Telephone Number	:	479-474-7771
Fax Number	:	479-474-3552

Provider Business Practice Location Address
First Line	:	400 FAYETTEVILLE ST
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-3502
Country	:	US
Telephone Number	:	479-474-7771
Fax Number	:	479-474-3552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	03/07/2023

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