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General NPI Number Information
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NPI Number | 1164846887
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Entity Type | Organization
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Legal Business Name | NORTHWEST ARKANSAS BREAST CARE SPECIALISTS, LTD.
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 03/02/2014
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Provider Practice Location Address
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Address Line | 701 S HORSEBARN RD SUITE 100
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City | ROGERS
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State | AR
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Zip | 72758-8737
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Country | US
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Telephone | 479-202-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 TOPPING RD
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City | SAINT LOUIS
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State | MO
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Zip | 63131-1421
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Country | US
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Telephone | 972-971-4620
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER ANTONIO MENENDEZ
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Credential | M.D.
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Telephone | 972-971-4630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | E-8334
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License Number State | AR
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