Provider Demographics
NPI:1407215916
Name:FAYETTEVILLE ARKANSAS HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:FAYETTEVILLE ARKANSAS HOSPITAL COMPANY LLC
Other - Org Name:NORTHWEST HEALTH PHYSICIANS' SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:3873 N PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6286
Mailing Address - Country:US
Mailing Address - Phone:479-571-7070
Mailing Address - Fax:479-571-7090
Practice Address - Street 1:3873 N PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6286
Practice Address - Country:US
Practice Address - Phone:479-571-7070
Practice Address - Fax:479-571-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR040152Medicare Oscar/Certification