Provider Demographics
NPI:1780697433
Name:NORTHWEST ARKANSAS PRIMARY CARE PHYSICIANS, PA
Entity type:Organization
Organization Name:NORTHWEST ARKANSAS PRIMARY CARE PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SALES/OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-845-0880
Mailing Address - Street 1:3400 SE MACY RD
Mailing Address - Street 2:STE 18
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7841
Mailing Address - Country:US
Mailing Address - Phone:479-845-0880
Mailing Address - Fax:
Practice Address - Street 1:3400 SE MACY RD
Practice Address - Street 2:STE 18
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7841
Practice Address - Country:US
Practice Address - Phone:479-845-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
E1802OtherSUBMITTER NUMBER
SF336Medicare ID - Type Unspecified