Provider Demographics
NPI:1891796538
Name:J MICHAEL STANDEFER MD PA
Entity Type:Organization
Organization Name:J MICHAEL STANDEFER MD PA
Other - Org Name:NEUROSURGICAL ASSOCIATES PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STANDEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-785-3400
Mailing Address - Street 1:520 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4641
Mailing Address - Country:US
Mailing Address - Phone:479-785-3400
Mailing Address - Fax:479-785-2295
Practice Address - Street 1:520 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4641
Practice Address - Country:US
Practice Address - Phone:479-785-3400
Practice Address - Fax:479-785-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F197OtherBCBS
5F197Medicare ID - Type Unspecified