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General NPI Number Information
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NPI Number | 1457783532
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTH ASSOCIATES
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Dates
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Enumeration Date | 07/31/2013
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 1792 E JOYCE BLVD SUITE 3
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-5253
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Country | US
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Telephone | 479-582-5805
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Fax | 479-582-5908
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Provider Business Mailing Address
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Address Line | PO BOX 9690
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0030
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Country | US
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Telephone | 479-582-5905
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Fax | 479-582-5908
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS ATKINSON
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Credential | M.D.
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Telephone | 479-582-5905
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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 | C5953
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License Number State | AR
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