Provider Demographics
NPI:1417967472
Name:RIVER VALLEY ANESTHESIA ASSOCIATES, P. A.
Entity Type:Organization
Organization Name:RIVER VALLEY ANESTHESIA ASSOCIATES, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-785-2555
Mailing Address - Street 1:2910 JENNY LIND
Mailing Address - Street 2:BLDG.#12
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-6735
Mailing Address - Country:US
Mailing Address - Phone:479-785-2555
Mailing Address - Fax:479-785-3555
Practice Address - Street 1:2910 JENNY LIND
Practice Address - Street 2:BLDG.#12
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-6735
Practice Address - Country:US
Practice Address - Phone:479-785-2555
Practice Address - Fax:479-785-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC2019207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKJ=========7Medicaid
OKJ=========7Medicaid