Healthcare Provider Details

I. General information

NPI: 1356662878
Provider Name (Legal Business Name): ELANGWE ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ROGERS AVE
FORT SMITH AR
72901-4164
US

IV. Provider business mailing address

2420 ROGERS AVE
FORT SMITH AR
72901-4164
US

V. Phone/Fax

Practice location:
  • Phone: 479-782-0244
  • Fax: 479-226-3148
Mailing address:
  • Phone: 479-782-0244
  • Fax: 479-226-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUZANNE ELIZABETH WARD
Title or Position: OFFICE MANAGER
Credential:
Phone: 479-782-0244