Provider Demographics
NPI: | 1508877903 |
---|---|
Name: | BOWEN HEFLEY RHODES STEWART ORTHOPEDICS, PA |
Entity type: | Organization |
Organization Name: | BOWEN HEFLEY RHODES STEWART ORTHOPEDICS, PA |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | SCOTT |
Authorized Official - Last Name: | BOWEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 501-663-6455 |
Mailing Address - Street 1: | 5220 NORTHSHORE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | NORTH LITTLE ROCK |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72118-5297 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 501-663-6455 |
Mailing Address - Fax: | 501-663-4877 |
Practice Address - Street 1: | 5220 NORTHSHORE DR |
Practice Address - Street 2: | |
Practice Address - City: | NORTH LITTLE ROCK |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72118-5297 |
Practice Address - Country: | US |
Practice Address - Phone: | 501-663-6455 |
Practice Address - Fax: | 501-663-4877 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-10 |
Last Update Date: | 2025-04-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AR | MC1434 | 207X00000X, 213E00000X, 207XS0106X, 207XX0004X, 207XX0005X, 207XX0801X, 207XS0114X |
208100000X, 225100000X, 261QP2000X | ||
AR | MD1434 | 213ES0103X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 207XX0801X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | Group - Multi-Specialty |
No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AR | 122050002 | Medicaid | |
AR | 152501742 | Medicaid | |
AR | 5C201 | Medicare PIN | |
AR | 152501742 | Medicaid |