Provider Demographics
NPI: | 1477888907 |
---|---|
Name: | FORT SMITH HMA PBC MANAGEMENT, LLC |
Entity Type: | Organization |
Organization Name: | FORT SMITH HMA PBC MANAGEMENT, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | SENIOR DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JAMES |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | WRIGHT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-465-7587 |
Mailing Address - Street 1: | PO BOX 689022 |
Mailing Address - Street 2: | |
Mailing Address - City: | FRANKLIN |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37068-9022 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-778-8000 |
Mailing Address - Fax: | 615-628-6877 |
Practice Address - Street 1: | 1001 TOWSON AVE |
Practice Address - Street 2: | |
Practice Address - City: | FORT SMITH |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72901-4921 |
Practice Address - Country: | US |
Practice Address - Phone: | 479-709-7399 |
Practice Address - Fax: | 479-709-7053 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-10-16 |
Last Update Date: | 2016-01-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AR | 5G434 | Medicare PIN | |
OK | OKB5907 | Medicare PIN |