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NPI Code Detail

MEDICARE: FORT SMITH HMA PBC MANAGEMENT, LLC

MEDICARE: FORT SMITH HMA PBC MANAGEMENT, LLC
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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1306269006
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT SMITH HMA PBC MANAGEMENT, LLC
Provider Business Mailing Address
First Line : PO BOX 402319
Second Line :
City : ATLANTA
State : GA
Zip : 30384-2319
Country : US
Telephone Number : 479-573-7990
Fax Number : 479-573-7991
Provider Business Practice Location Address
First Line : 4700 KELLEY HWY STE B
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-5024
Country : US
Telephone Number : 479-573-7990
Fax Number : 479-573-7991
Authorized Official
Title or Position : PRESIDENT, HMPN
Name : STACY LUCIUS
Credential :
Telephone Number : 239-552-3575
Provider Enumeration Date : 01/31/2014
Last Update Date : 01/31/2014

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