MEDICARE: WESTERN ARKANSAS PLASTIC & RECONSTRUCTIVE SURGERY CENTER

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	208200000X	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	:	1194730077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN ARKANSAS PLASTIC & RECONSTRUCTIVE SURGERY CENTER

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	:	479-709-8315

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	:	OWNER
Name	:	JAMES E KELLY III
Credential	:	M.D.
Telephone Number	:	479-709-8300

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	01/08/2020

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Directions to “WESTERN ARKANSAS PLASTIC & RECONSTRUCTIVE SURGERY CENTER ” Practice Location

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