Provider Demographics
NPI:1992848162
Name:ALBERT SAMUEL KOENIG, III, PA
Entity Type:Organization
Organization Name:ALBERT SAMUEL KOENIG, III, PA
Other - Org Name:FAMILY MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:KOENIG
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:479-782-4000
Mailing Address - Street 1:2420 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4164
Mailing Address - Country:US
Mailing Address - Phone:479-782-4000
Mailing Address - Fax:479-782-0265
Practice Address - Street 1:2420 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4164
Practice Address - Country:US
Practice Address - Phone:479-782-4000
Practice Address - Fax:479-782-0265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBERT SAMUEL KOENIG, III, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4336207Q00000X, 207ZP0101X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110246002Medicaid
AR5B289OtherARKANSAS BLUE CROSS & BLU
AR110246002Medicaid
ARC68639Medicare UPIN