Provider Demographics
NPI:1619389152
Name:ARKANSAS MEDICAL & WELLNESS PA
Entity Type:Organization
Organization Name:ARKANSAS MEDICAL & WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-361-4192
Mailing Address - Street 1:3400 SE MACY RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7841
Mailing Address - Country:US
Mailing Address - Phone:479-845-4476
Mailing Address - Fax:479-286-0061
Practice Address - Street 1:3400 SE MACY RD
Practice Address - Street 2:SUITE 18
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7841
Practice Address - Country:US
Practice Address - Phone:479-845-4476
Practice Address - Fax:479-286-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization