Provider Demographics
NPI:1740509140
Name:GR8 FOXX ANESTHESIA, LTD.
Entity type:Organization
Organization Name:GR8 FOXX ANESTHESIA, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTON
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GROTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-582-1938
Mailing Address - Street 1:3396 N FUTRALL DR
Mailing Address - Street 2:STE. 1
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4057
Mailing Address - Country:US
Mailing Address - Phone:479-582-1938
Mailing Address - Fax:479-587-0484
Practice Address - Street 1:3396 N FUTRALL DR
Practice Address - Street 2:STE. 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-582-1938
Practice Address - Fax:479-587-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty