Provider Demographics
NPI:1750028593
Name:HEALTH LANES LLC
Entity Type:Organization
Organization Name:HEALTH LANES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:DE MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-285-1255
Mailing Address - Street 1:3790 N BELLAFONT BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5481
Mailing Address - Country:US
Mailing Address - Phone:479-439-0777
Mailing Address - Fax:888-815-1613
Practice Address - Street 1:3790 N BELLAFONT BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5481
Practice Address - Country:US
Practice Address - Phone:479-439-0777
Practice Address - Fax:888-815-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty