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General NPI Number Information
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NPI Number | 1356319164
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Entity Type | Organization
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Legal Business Name | BENTONVILLE PEDIATRICS
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2719 SE I ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-3996
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Country | US
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Telephone | 479-273-5437
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Fax | 479-273-9932
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 479-968-4273
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Fax | 479-968-1363
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Authorized Official
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Title or Position | OWNER
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Name | MR. JASON B FOSTER
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Credential | M.D.
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Telephone | 479-273-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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