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NPI Code Detail

MEDICARE: DR. BRADLEY M. SHORT, D.O., P.A.

MEDICARE: DR. BRADLEY M. SHORT, D.O., P.A.
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
1208100000XPhysical Medicine & Rehabilitation PhysicianC7559AR

Other Identifiers

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

General Provider Information

NPI Number : 1710215041
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR. BRADLEY M. SHORT, D.O., P.A.
Provider Business Mailing Address
First Line : 3905 BROOKEN HILL DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-9282
Country : US
Telephone Number : 479-646-3345
Fax Number : 478-646-6049
Provider Business Practice Location Address
First Line : 3905 BROOKEN HILL DR
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-9282
Country : US
Telephone Number : 479-646-3345
Fax Number : 478-646-6049
Authorized Official
Title or Position : PRESIDEN
Name : DR. BRADLEY MARK SHORT
Credential : D.O.
Telephone Number : 479-646-3345
Provider Enumeration Date : 11/24/2009
Last Update Date : 11/24/2009

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Practice Location Address:
3905 BROOKEN HILL DR
FORT SMITH, AR
72908-9282
Practice Phone: 479-646-3345
Practice Fax: 479-646-6049
1740075720 — THRIVE NEUROHEALTH, LLC.
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FORT SMITH, AR
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1417942731 — LAWS VILLAGE PHARMACY, INC.
Practice Location Address:
2504 MARKET TRCE
FORT SMITH, AR
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1104812767 — MRS. ALLISON D CLEM RPH
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1710974274 — KMJ ENTERPRISES FIANNA HILLS LLC
Practice Location Address:
8411 S 28TH ST
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Practice Fax: 479-648-9673

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