Provider Demographics
NPI:1346284528
Name:HAISTEN, JAMES A S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A S
Last Name:HAISTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18415 BLUE SPRINGS RD.
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703
Mailing Address - Country:US
Mailing Address - Phone:479-443-0102
Mailing Address - Fax:
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5379
Practice Address - Country:US
Practice Address - Phone:479-750-2203
Practice Address - Fax:479-750-1193
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2395207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122720000OtherQUAL CHOICE
OK100161990AMedicaid
MO202372900Medicaid
AR106402001Medicaid
ARR2395OtherAR STATE LICENSE
ARR2395OtherAR STATE LICENSE
AR52078Medicare ID - Type UnspecifiedAR MEDICARE
AR106402001Medicaid
ARP00140162Medicare PIN