MEDICARE: DR. JAMES E. KELLY III M.D.

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	E0847	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144289331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E. KELLY III M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10810
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-0810
Country	:	US
Telephone Number	:	479-709-8300
Fax Number	:	709-709-8315

Provider Business Practice Location Address
First Line	:	8101 MCCLURE DR STE 301
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6056
Country	:	US
Telephone Number	:	479-709-8300
Fax Number	:	479-709-8315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	01/08/2020

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