Healthcare Provider Details

I. General information

NPI: 1609419266
Provider Name (Legal Business Name): NORTH ARKANSAS ORTHOPEDIC & SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 LINWOOD DR STE A
PARAGOULD AR
72450-5818
US

IV. Provider business mailing address

1507 LINWOOD DR STE A
PARAGOULD AR
72450-5818
US

V. Phone/Fax

Practice location:
  • Phone: 870-239-8102
  • Fax: 870-239-8105
Mailing address:
  • Phone: 870-335-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS D RICHARDSON
Title or Position: OWNER
Credential:
Phone: 815-993-6699