Healthcare Provider Details

I. General information

NPI: 1780697433
Provider Name (Legal Business Name): NORTHWEST ARKANSAS PRIMARY CARE PHYSICIANS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 479-845-0880
  • Fax:
Mailing address:
  • Phone: 479-845-0880
  • Fax:

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: BRET RAYMOND
Title or Position: DIRECTOR OF SALES/OPERATIONS
Credential:
Phone: 479-845-0880