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NPI Code Detail

MEDICARE: TBD HEALTH ENTERPRISES OF ARKANSAS PLLC

MEDICARE: TBD HEALTH ENTERPRISES 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
1208VP0014XInterventional Pain Medicine Physician

General Provider Information

NPI Number : 1760242440
Entity Type Code : Organization
Provider Name (Legal Business Name) : TBD HEALTH ENTERPRISES OF ARKANSAS PLLC
Provider Business Mailing Address
First Line : 2707 MARKET TRCE
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8694
Country : US
Telephone Number : 479-434-3600
Fax Number : 833-992-0797
Provider Business Practice Location Address
First Line : 2707 MARKET TRCE
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8694
Country : US
Telephone Number : 479-434-3600
Fax Number : 833-992-0797
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : THOMAS BENJAMIN DE MIRANDA
Credential : MD
Telephone Number : 479-434-3600
Provider Enumeration Date : 03/20/2024
Last Update Date : 03/20/2025

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Directions to “TBD HEALTH ENTERPRISES OF ARKANSAS PLLC ” Practice Location

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