Provider Demographics
NPI:1750472114
Name:WESTERN ARKANSAS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:WESTERN ARKANSAS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ROWLAND
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-484-5600
Mailing Address - Street 1:PO BOX 11546
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1546
Mailing Address - Country:US
Mailing Address - Phone:479-484-5600
Mailing Address - Fax:479-484-5612
Practice Address - Street 1:3420 S 74TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5026
Practice Address - Country:US
Practice Address - Phone:479-484-5600
Practice Address - Fax:479-484-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F647Medicare PIN