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General NPI Number Information
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NPI Number | 1740238823
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Entity Type | Organization
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Legal Business Name | SPARKS MEDICAL FOUNDATION
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 1500 DODSON AVE STE 140
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City | FORT SMITH
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State | AR
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Zip | 72901-5182
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Country | US
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Telephone | 479-709-1913
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Fax | 479-709-1998
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Provider Business Mailing Address
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Address Line | PO BOX 2420
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City | FORT SMITH
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State | AR
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Zip | 72902-2420
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Country | US
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Telephone | 479-709-7399
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Fax | 479-709-7053
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Authorized Official
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Title or Position | CBO SUPPORT MANAGER
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Name | REBECCA COX
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Credential |
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Telephone | 479-709-7057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | RT2641
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | RT2641
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 2471B0102X
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Taxonomy Name | Bone Densitometry Radiologic Technologist
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License Number | RT2641
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License Number State | AR
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