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General NPI Number Information
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NPI Number | 1770871881
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Entity Type | Organization
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Legal Business Name | FORT SMITH MEDICAL CENTER LLC
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 3811 ROGERS AVE SUITE A
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City | FORT SMITH
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State | AR
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Zip | 72903-3045
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Country | US
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Telephone | 479-434-3131
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Fax | 479-434-3135
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Provider Business Mailing Address
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Address Line | PO BOX 11316
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City | FORT SMITH
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State | AR
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Zip | 72917-1316
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Country | US
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Telephone | 479-434-3131
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Fax | 479-434-3135
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TONYA DEANN BEINEMAN
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Credential | APN RNP
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Telephone | 479-434-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A01596
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License Number State | AR
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