Healthcare Provider Details

I. General information

NPI: 1164039475
Provider Name (Legal Business Name): PASSMORE PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 MCCLURE DR STE 100
FORT SMITH AR
72916-6044
US

IV. Provider business mailing address

8101 MCCLURE DR STE 100
FORT SMITH AR
72916-6044
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-2442
  • Fax: 479-242-4220
Mailing address:
  • Phone: 479-242-2442
  • Fax: 479-242-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANN K PASSMORE
Title or Position: OWNER
Credential: MD
Phone: 479-242-2442