Healthcare Provider Details
I. General information
NPI: 1255110110
Provider Name (Legal Business Name): SEBASTIAN PHYSICIAN SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1001 TOWSON AVE
FORT SMITH AR
72901-4921
US
IV. Provider business mailing address
200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US
V. Phone/Fax
- Phone: 479-441-4000
- Fax:
- Phone: 800-893-9698
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208M00000X |
| Taxonomy | Hospitalist Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
DAVID
SCHILLINGER
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 337-609-1221