=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811073273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWBORN REGIONAL PROVIDERS PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2006
-----------------------------------------------------
Last Update Date | 09/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10608 INVERNESS ST
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72908-0703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-739-8043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11350
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72917-1350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-739-8043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VICTOR F COLOSO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 479-739-8043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------