Provider Demographics
NPI:1013940394
Name:WALTER W. HAYES, D.P.M., P.A.
Entity Type:Organization
Organization Name:WALTER W. HAYES, D.P.M., P.A.
Other - Org Name:FAMILY FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:WADSWORTH
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:870-934-8200
Mailing Address - Street 1:PO BOX 16712
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 WINDOVER
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-934-8200
Practice Address - Fax:870-934-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR216213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARDG6938OtherRAILROAD GROUP
AR162673748Medicaid
AR5F693OtherBCBS GROUP
AR5797360001Medicare NSC
AR5F693Medicare PIN