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General NPI Number Information
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NPI Number | 1215489604
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Entity Type | Organization
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Legal Business Name | NASSRI PEDIATRICS AND PULMONOLOGY, LLC
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 9207 HIGHWAY 71 S SUITE 9
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City | FORT SMITH
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State | AR
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Zip | 72916-9117
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Country | US
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Telephone | 479-434-6140
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Fax | 479-434-6144
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Provider Business Mailing Address
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Address Line | PO BOX 10718
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City | FORT SMITH
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State | AR
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Zip | 72917-0718
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Country | US
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Telephone | 479-221-3732
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Fax | 479-649-8275
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Authorized Official
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Title or Position | PEDIATRIC PULMONOLOGIST
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Name | DR. LOUAY K NASSRI
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Credential | MD
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Telephone | 479-221-3732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R-2933
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License Number State | AR
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