Provider Demographics
NPI:1841548427
Name:DREW PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:DREW PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-460-3569
Mailing Address - Street 1:750 H L ROSS DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-5705
Mailing Address - Country:US
Mailing Address - Phone:870-367-9700
Mailing Address - Fax:870-460-0077
Practice Address - Street 1:778 SCOGIN DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5729
Practice Address - Country:US
Practice Address - Phone:870-367-9700
Practice Address - Fax:870-460-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167896002Medicaid
AR5F911Medicare PIN