Provider Demographics
NPI:1285847590
Name:COLON AND RECTAL CLINIC OF NWA
Entity Type:Organization
Organization Name:COLON AND RECTAL CLINIC OF NWA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KA
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-770-0728
Mailing Address - Street 1:212 W MONROE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9451
Mailing Address - Country:US
Mailing Address - Phone:479-770-0728
Mailing Address - Fax:479-770-0712
Practice Address - Street 1:212 W MONROE AVE STE A
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9451
Practice Address - Country:US
Practice Address - Phone:479-770-0728
Practice Address - Fax:479-770-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3918174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty