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General NPI Number Information
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NPI Number | 1508103029
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Entity Type | Organization
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Legal Business Name | OPTIMUM AGING & INTEGRATED MEDICINE
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Dates
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Enumeration Date | 01/04/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 2641 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4145
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Country | US
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Telephone | 479-784-0011
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Fax | 479-784-0012
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Provider Business Mailing Address
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Address Line | PO BOX 7132
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City | VAN BUREN
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State | AR
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Zip | 72956-0124
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Country | US
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Telephone | 479-784-0011
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Fax | 479-784-0012
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Authorized Official
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Title or Position | OWNER
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Name | TERRY L HOYT
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Credential | D.O
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Telephone | 479-784-0011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2789
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-2638
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License Number State | AR
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