MEDICARE: FORT SMITH RADIATION ONCOLOGY

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	2085R0001X	Radiation Oncology Physician	E1533	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	:	1215107008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT SMITH RADIATION ONCOLOGY

Provider Business Mailing Address
First Line	:	PO BOX 5710
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72913-5710
Country	:	US
Telephone Number	:	479-648-1800
Fax Number	:	479-434-5899

Provider Business Practice Location Address
First Line	:	8500 S 36TH TER
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8880
Country	:	US
Telephone Number	:	479-648-1800
Fax Number	:	479-434-5899

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	BECKY D FITZPATRICK
Credential	:
Telephone Number	:	479-648-1800

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	07/14/2011

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