Provider Demographics
NPI:1952671703
Name:WESTERN ARKANSAS OBSTETRIC ANESTHESIA LLC
Entity Type:Organization
Organization Name:WESTERN ARKANSAS OBSTETRIC ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-452-1581
Mailing Address - Street 1:PO BOX 11880
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1880
Mailing Address - Country:US
Mailing Address - Phone:479-452-1581
Mailing Address - Fax:479-452-2148
Practice Address - Street 1:2301 S 56TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3755
Practice Address - Country:US
Practice Address - Phone:479-452-1581
Practice Address - Fax:479-452-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty