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General NPI Number Information
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NPI Number | 1992848162
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Entity Type | Organization
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Legal Business Name | ALBERT SAMUEL KOENIG, III, PA
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 2420 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4164
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Country | US
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Telephone | 479-782-4000
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Fax | 479-782-0265
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Provider Business Mailing Address
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Address Line | 2420 ROGERS AVE
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City | FORT SMITH
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State | AR
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Zip | 72901-4164
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Country | US
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Telephone | 479-782-4000
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Fax | 479-782-0265
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Authorized Official
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Title or Position | CORPORATION PRESIDENT
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Name | DR. ALBERT SAMUEL KOENIG III
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Credential | M.D.
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Telephone | 479-782-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | C4336
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | C4336
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C4336
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License Number State | AR
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