Healthcare Provider Details

I. General information

NPI: 1174363725
Provider Name (Legal Business Name): BISHAL POUDEL MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 02/10/2025
Certification Date:
Deactivation Date: 01/14/2025
Reactivation Date: 02/10/2025

III. Provider practice location address

7301 ROGERS AVE, MERCY HOSPITAL FORT SMITH, ATTN: GME D
FORTH SMITH AR
72903
US

IV. Provider business mailing address

7301 ROGERS AVE, MERCY HOSPITAL FORT SMITH, ATTN: GME D
FORTH SMITH AR
72903
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6000
  • Fax: 479-314-4705
Mailing address:
  • Phone: 479-314-6000
  • Fax: 479-314-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: