Healthcare Provider Details

I. General information

NPI: 1144620683
Provider Name (Legal Business Name): BATESVILLE SPINE AND HEALTH SOLUTIONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 HARRISON ST STE A
BATESVILLE AR
72501-6949
US

IV. Provider business mailing address

PO BOX 2731
BATESVILLE AR
72503-2731
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4909
  • Fax: 870-569-4895
Mailing address:
  • Phone: 870-569-4909
  • Fax: 870-569-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE6051
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL JORDAN WEAVER
Title or Position: OWNER
Credential: M.D.
Phone: 870-569-4909