Provider Demographics
NPI:1740219997
Name:COLON & RECTAL SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:COLON & RECTAL SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:NOWLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-443-9443
Mailing Address - Street 1:3000 N MARKET AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3514
Mailing Address - Country:US
Mailing Address - Phone:479-443-9443
Mailing Address - Fax:479-443-4895
Practice Address - Street 1:3000 N MARKET AVE
Practice Address - Street 2:SUITE D
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3514
Practice Address - Country:US
Practice Address - Phone:479-443-9443
Practice Address - Fax:479-443-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-1354208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F005Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER