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General NPI Number Information
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NPI Number | 1750508545
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Entity Type | Organization
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Legal Business Name | MYERS PROFESSIONAL MEDICAL SERVICES
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1808 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2724
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Country | US
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Telephone | 479-967-0799
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Fax | 479-967-0798
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Provider Business Mailing Address
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Address Line | 920 HILLTOP DR
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City | RUSSELLVILLE
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State | AR
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Zip | 72802-8645
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Country | US
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Telephone | 479-967-0799
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Fax | 479-968-0798
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES MARK MYERS
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Credential | MD
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Telephone | 479-967-0799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C5125
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License Number State | AR
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