Healthcare Provider Details

I. General information

NPI: 1619389152
Provider Name (Legal Business Name): ARKANSAS MEDICAL & WELLNESS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SE MACY RD SUITE 18
BENTONVILLE AR
72712-7841
US

IV. Provider business mailing address

3400 SE MACY RD SUITE 18
BENTONVILLE AR
72712-7841
US

V. Phone/Fax

Practice location:
  • Phone: 479-845-4476
  • Fax: 479-286-0061
Mailing address:
  • Phone: 479-845-4476
  • Fax: 479-286-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: STEVE SWIFT
Title or Position: ADMINISTRATOR
Credential:
Phone: 918-361-4192