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General NPI Number Information
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NPI Number | 1316131048
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Entity Type | Organization
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Legal Business Name | DREW PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 750 HL ROSS DRIVE
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City | MONTICELLO
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State | AR
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Zip | 71655-5705
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Country | US
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Telephone | 870-460-3514
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Fax | 870-460-3565
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Provider Business Mailing Address
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Address Line | 750 HL ROSS DRIVE
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City | MONTICELLO
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State | AR
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Zip | 71655
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Country | US
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Telephone | 870-460-3514
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Fax | 870-460-3565
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Authorized Official
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Title or Position | BUSINESS OFFICE DIRECTOR
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Name | VONDA RUSSELL
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Credential |
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Telephone | 870-460-3514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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