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General NPI Number Information
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NPI Number | 1831463215
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Entity Type | Organization
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Legal Business Name | ACADEMIC PHYSICIANS SPECIALTY LLC
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 05/10/2012
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Provider Practice Location Address
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Address Line | 1125 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1908
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Country | US
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Telephone | 479-684-5191
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Fax | 479-571-1801
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Provider Business Mailing Address
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Address Line | 1125 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1908
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Country | US
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Telephone | 479-684-5191
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Fax | 479-571-1801
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CALVIN J SMITH
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Credential |
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Telephone | 479-684-5191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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