Provider Demographics
NPI:1790187573
Name:WESTERN ARKANSAS ORTHOPEDIC CLINIC,PLLC
Entity Type:Organization
Organization Name:WESTERN ARKANSAS ORTHOPEDIC CLINIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RHOMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-262-2504
Mailing Address - Street 1:2010 CHESTNUT ST STE F
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5340
Mailing Address - Country:US
Mailing Address - Phone:479-262-2504
Mailing Address - Fax:479-262-2509
Practice Address - Street 1:2010 CHESTNUT ST STE F
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5340
Practice Address - Country:US
Practice Address - Phone:479-262-2504
Practice Address - Fax:479-262-2509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4554207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty