MEDICARE: COLON AND RECTAL ASSOCIATES OF ARKANSAS, PLLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1528218237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLON AND RECTAL ASSOCIATES OF ARKANSAS, PLLC

Provider Business Mailing Address
First Line	:	3302 N. NORTH HILLS BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-443-9443
Fax Number	:	479-443-4895

Provider Business Practice Location Address
First Line	:	3302 N. NORTH HILLS BLVD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3507
Country	:	US
Telephone Number	:	479-443-9443
Fax Number	:	479-443-4895

Authorized Official
Title or Position	:	CLINIC MANAGER
Name	:	MRS. JANA HOLT
Credential	:
Telephone Number	:	479-443-9443

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	09/30/2008

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