MEDICARE: FORT SMITH MEDICAL CENTER 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
1	363L00000X	Nurse Practitioner	A01596	AR

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	:	1770871881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT SMITH MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 11316
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-1316
Country	:	US
Telephone Number	:	479-434-3131
Fax Number	:	479-434-3135

Provider Business Practice Location Address
First Line	:	3811 ROGERS AVE
Second Line	:	SUITE A
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3045
Country	:	US
Telephone Number	:	479-434-3131
Fax Number	:	479-434-3135

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TONYA DEANN BEINEMAN
Credential	:	APN RNP
Telephone Number	:	479-434-3131

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	09/02/2011

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Directions to “FORT SMITH MEDICAL CENTER LLC ” Practice Location

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