Healthcare Provider Details

I. General information

NPI: 1205595378
Provider Name (Legal Business Name): GRACE & HOPE MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 EUPER LN STE B
FORT SMITH AR
72903-3255
US

IV. Provider business mailing address

2916 KELLS ABBEY
FORT SMITH AR
72908-9317
US

V. Phone/Fax

Practice location:
  • Phone: 479-769-2519
  • Fax: 501-510-5917
Mailing address:
  • Phone: 479-769-2519
  • Fax: 501-510-5917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GINA VARGAS
Title or Position: OWNER
Credential: MD
Phone: 479-769-2519