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General NPI Number Information
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NPI Number | 1295032407
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN SPECIALISTS OF NWA, PLLC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 509 E MILLSAP RD STE 109
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4862
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Country | US
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Telephone | 479-595-8192
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Fax | 479-442-1748
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Provider Business Mailing Address
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Address Line | 509 E MILLSAP RD STE 109
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4862
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Country | US
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Telephone | 479-595-8192
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Fax | 479-442-1748
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | MISS LODDIE CONWAY
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Credential |
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Telephone | 479-595-8192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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