Provider Demographics
NPI:1235194689
Name:WESTERN ARKANSAS HEART LUNG & VASCULAR SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:WESTERN ARKANSAS HEART LUNG & VASCULAR SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:479-478-7059
Mailing Address - Street 1:2713 S 74TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5170
Mailing Address - Country:US
Mailing Address - Phone:479-478-7059
Mailing Address - Fax:479-478-7061
Practice Address - Street 1:2713 S 74TH ST
Practice Address - Street 2:104
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5170
Practice Address - Country:US
Practice Address - Phone:479-478-7059
Practice Address - Fax:479-478-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8359174400000X
ARR3835174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH8694OtherRAILROAD MEDICARE GROUP
AR123788001Medicaid
AR114669001Medicaid
AR142620002Medicaid
CH8694OtherRAILROAD MEDICARE GROUP
ARF59451Medicare UPIN
AR52171Medicare ID - Type UnspecifiedROBERT C JAGGERS MD
AR114669001Medicaid
AR123788001Medicaid