=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174187132
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2019
-----------------------------------------------------
Last Update Date | 04/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3800 ROGERS AVE STE 6
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72903-3075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-782-2500
-----------------------------------------------------
Fax | 479-782-8557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 497
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72006-0497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-347-2534
-----------------------------------------------------
Fax | 870-347-1235
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | STEVEN COLLIER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 870-347-3300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------