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General NPI Number Information
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NPI Number | 1447490446
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Entity Type | Organization
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Legal Business Name | DSW ANESTHESIA SERVICES LLC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 3002 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4232
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Country | US
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Telephone | 479-785-2555
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Fax | 479-785-3555
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Provider Business Mailing Address
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Address Line | PO BOX 11405
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City | FORT SMITH
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State | AR
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Zip | 72917-1405
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Country | US
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Telephone | 479-785-2555
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Fax | 479-785-3555
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONOVAN S WILLIS
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Credential | CRNA
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Telephone | 479-462-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C01497
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License Number State | AR
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