Healthcare Provider Details

I. General information

NPI: 1851620751
Provider Name (Legal Business Name): NW PHYSICIANS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GREATHOUSE SPRINGS ROAD
JOHNSON AR
72741
US

IV. Provider business mailing address

PO BOX 1069
LOWELL AR
72745-1069
US

V. Phone/Fax

Practice location:
  • Phone: 479-684-3000
  • Fax: 479-750-0572
Mailing address:
  • Phone: 479-756-9199
  • Fax: 479-750-0572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberA03322 APN
License Number StateAR

VIII. Authorized Official

Name: MR. EDDIE KLEIN
Title or Position: CFO
Credential:
Phone: 479-757-4008