Provider Demographics
NPI:1770871881
Name:FORT SMITH MEDICAL CENTER LLC
Entity type:Organization
Organization Name:FORT SMITH MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:BEINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APN RNP
Authorized Official - Phone:479-434-3131
Mailing Address - Street 1:PO BOX 11316
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1316
Mailing Address - Country:US
Mailing Address - Phone:479-434-3131
Mailing Address - Fax:479-434-3135
Practice Address - Street 1:3811 ROGERS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3045
Practice Address - Country:US
Practice Address - Phone:479-434-3131
Practice Address - Fax:479-434-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141581758Medicaid
AR141581758Medicaid
AR5W155Medicare PIN