Healthcare Provider Details

I. General information

NPI: 1346175387
Provider Name (Legal Business Name): WASHINGTON REGIONAL MEDICAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E APPLEBY ROAD SUITE 203
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

P.O. BOX 190
LOWELL AR
72745
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-8080
  • Fax: 479-463-8162
Mailing address:
  • Phone: 479-463-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES LAWRENCE SHACKELFORD
Title or Position: CEO
Credential:
Phone: 479-463-6003