Provider Demographics
NPI:1386674224
Name:EUBANKS, CHARLES W (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11880
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1880
Mailing Address - Country:US
Mailing Address - Phone:479-452-1581
Mailing Address - Fax:479-452-2148
Practice Address - Street 1:2301 S 56TH ST
Practice Address - Street 2:STE 110
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3755
Practice Address - Country:US
Practice Address - Phone:479-452-1581
Practice Address - Fax:479-452-2148
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR32900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T376Medicare PIN