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General NPI Number Information
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NPI Number | 1982648663
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Entity Type | Organization
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Legal Business Name | NORTHWEST ARKANSAS HEART & VASCULAR CENTER
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 3211 N. NORTH HILLS BLVD. SUITE 110
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-571-4338
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Fax | 479-571-4015
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Provider Business Mailing Address
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Address Line | 3211 N. NORTH HILLS BLVD. SUITE 110
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City | FAYETTEVILLE
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State | AR
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Zip | 72703
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Country | US
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Telephone | 479-571-4338
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Fax | 479-571-4015
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROSE SMITHSON
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Credential |
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Telephone | 479-571-4338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | MC1831
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License Number State | AR
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