MEDICARE: SPIRIT MED, INCORPORATED

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	207Q00000X	Family Medicine Physician	E0883	AR

General Provider Information

NPI Number	:	1073689485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRIT MED, INCORPORATED

Provider Business Mailing Address
First Line	:	400 FAYETTVILLE ROAD
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956
Country	:	US
Telephone Number	:	479-474-7771
Fax Number	:	479-474-3552

Provider Business Practice Location Address
First Line	:	400 FAYETTEVILLE ST
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-3502
Country	:	US
Telephone Number	:	479-474-7771
Fax Number	:	479-474-3552

Authorized Official
Title or Position	:	DO
Name	:	DR. GEORGE H TOMPKINS
Credential	:	DO
Telephone Number	:	479-474-7771

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	05/07/2009

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Directions to “SPIRIT MED, INCORPORATED ” Practice Location

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