MEDICARE: ARCHIE L. HEWETT, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician		AR

General Provider Information

NPI Number	:	1073662441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCHIE L. HEWETT, M.D., P.A.

Provider Business Mailing Address
First Line	:	600 S 14TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4706
Country	:	US
Telephone Number	:	479-785-2604
Fax Number	:	479-785-2694

Provider Business Practice Location Address
First Line	:	600 S 14TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4706
Country	:	US
Telephone Number	:	479-785-2604
Fax Number	:	479-785-2694

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARCHIE LAVERN HEWETT
Credential	:	M.D.
Telephone Number	:	479-785-2604

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/27/2007

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