=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609892330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENERAL ORTHOPAEDICS AND ADULT SPINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 12/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 S MAIN ST
-----------------------------------------------------
City | SEARCY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72143-7319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-278-3154
-----------------------------------------------------
Fax | 501-278-3455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 AUTUMN RD
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72211-3702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-278-3154
-----------------------------------------------------
Fax | 501-278-3455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PHYSICIAN SERVICES
-----------------------------------------------------
Name | DENISE LYNN BELFORD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-278-3154
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------