Provider Demographics
NPI:1043225709
Name:THE CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:THE CENTER FOR PEDIATRICS AND ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHESHIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:479-785-2825
Mailing Address - Street 1:3222 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5050
Mailing Address - Country:US
Mailing Address - Phone:479-785-2825
Mailing Address - Fax:479-782-6630
Practice Address - Street 1:3222 S 70TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5050
Practice Address - Country:US
Practice Address - Phone:479-785-2825
Practice Address - Fax:479-782-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5272174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90075Medicare UPIN