Provider Demographics
NPI:1942390158
Name:FRED L SMARDO, M.D., PA
Entity Type:Organization
Organization Name:FRED L SMARDO, M.D., PA
Other - Org Name:ARKANSAS KIDNEY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-751-6004
Mailing Address - Street 1:307 S THOMPSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4240
Mailing Address - Country:US
Mailing Address - Phone:479-751-6004
Mailing Address - Fax:479-751-3408
Practice Address - Street 1:307 S THOMPSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4240
Practice Address - Country:US
Practice Address - Phone:479-751-6004
Practice Address - Fax:479-751-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F253Medicare PIN