Provider Demographics
NPI:1295032407
Name:INTERVENTIONAL PAIN SPECIALISTS OF NWA, PLLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS OF NWA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LODDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-595-8192
Mailing Address - Street 1:509 E MILLSAP RD STE 109
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4862
Mailing Address - Country:US
Mailing Address - Phone:479-595-8192
Mailing Address - Fax:479-442-1748
Practice Address - Street 1:509 E MILLSAP RD STE 109
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4862
Practice Address - Country:US
Practice Address - Phone:479-595-8192
Practice Address - Fax:479-442-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty