Provider Demographics
NPI:1659310381
Name:ADVANCED ORTHOPAEDIC SPECIALISTS, PLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPAEDIC SPECIALISTS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SITES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-966-4187
Mailing Address - Street 1:PO BOX 10648
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0046
Mailing Address - Country:US
Mailing Address - Phone:479-966-4187
Mailing Address - Fax:479-935-4064
Practice Address - Street 1:1420 HIGHWAY 62 65 N STE A
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1959
Practice Address - Country:US
Practice Address - Phone:870-741-7443
Practice Address - Fax:870-741-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146105002Medicaid
ARRR13670OtherRAILROAD MEDICARE
AR5C595Medicare ID - Type Unspecified