Provider Demographics
NPI:1851754345
Name:WASHINGTON REGIONAL MEDICAL SYSTEM
Entity Type:Organization
Organization Name:WASHINGTON REGIONAL MEDICAL SYSTEM
Other - Org Name:NORTHWEST ARKANSAS NEUROSURGERY CLINIC - WASHINGTON REGIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ECKELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-463-2825
Mailing Address - Street 1:3561 JOHNSON MILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704
Mailing Address - Country:US
Mailing Address - Phone:479-404-4500
Mailing Address - Fax:479-404-4510
Practice Address - Street 1:3561 JOHNSON MILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704
Practice Address - Country:US
Practice Address - Phone:479-404-4500
Practice Address - Fax:479-404-4510
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON REGIONAL MEDICAL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-01
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty