Provider Demographics
NPI:1003360082
Name:HEALTHMAX CENTER LLC
Entity Type:Organization
Organization Name:HEALTHMAX CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-755-6595
Mailing Address - Street 1:12300 HIGHWAY 71 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9133
Mailing Address - Country:US
Mailing Address - Phone:479-755-6595
Mailing Address - Fax:479-755-6596
Practice Address - Street 1:12300 HIGHWAY 71 S
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9133
Practice Address - Country:US
Practice Address - Phone:479-755-6595
Practice Address - Fax:479-755-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-5521208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC68705Medicare UPIN