MEDICARE: NORTHWEST ARKANSAS HOSPITALS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RC0001X	Clinical Cardiac Electrophysiology Physician
2	2085R0202X	Diagnostic Radiology Physician
3	2085R0203X	Therapeutic Radiology Physician
4	246W00000X	Cardiology Technician
5	247100000X	Radiologic Technologist
6	133V00000X	Registered Dietitian
7	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316053242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST ARKANSAS HOSPITALS LLC

Provider Business Mailing Address
First Line	:	PO BOX 840448
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0448
Country	:	US
Telephone Number	:	479-684-3064
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 W MAPLE AVE
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-5335
Country	:	US
Telephone Number	:	479-751-5711
Fax Number	:	479-757-2908

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	615-465-7626

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	06/05/2008

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1689676272 — REGENCY HOSPITAL OF NORTHWEST ARKANSAS, LLC
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