Healthcare Provider Details

I. General information

NPI: 1508593476
Provider Name (Legal Business Name): ONSITE NEONATAL ARKANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

1000 HADDONFIELD BERLIN RD STE 210
VOORHEES NJ
08043-3520
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6000
  • Fax:
Mailing address:
  • Phone: 856-782-2212
  • Fax: 856-679-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARY BAIN
Title or Position: VP OF FINANCE
Credential:
Phone: 856-782-2212