Healthcare Provider Details

I. General information

NPI: 1619937745
Provider Name (Legal Business Name): ORTHOPAEDICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 WE KNIGHT DR
FORT SMITH AR
72903-6248
US

IV. Provider business mailing address

PO BOX 11230 3501 W. E. KNIGHT DRIVE
FORT SMITH AR
72917-1230
US

V. Phone/Fax

Practice location:
  • Phone: 479-709-6700
  • Fax: 479-709-6768
Mailing address:
  • Phone: 479-709-6767
  • Fax: 479-709-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH J BOLYARD
Title or Position: PRESIDENT
Credential: M.D..
Phone: 479-709-6700