| Northwest Arkansas Integrated Medical, Inc | |
|
1300 Se 14th St Ste 2 Bentonville AR 72712-6814 | |
| (479) 271-6992 | |
| Not Available |
| Full Name | Northwest Arkansas Integrated Medical, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1300 Se 14th St Ste 2, Bentonville, Arkansas |
| Authorized Official Name and Position | Jeffrey Smith (OWNER) |
| Authorized Official Contact | 4795315533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwest Arkansas Integrated Medical, Inc 1300 Se 14th St Ste 2 Bentonville AR 72712-6814 Ph: () - | Northwest Arkansas Integrated Medical, Inc 1300 Se 14th St Ste 2 Bentonville AR 72712-6814 Ph: (479) 271-6992 |
| NPI Number | 1801439302 |
|---|---|
| Provider Enumeration Date | 10/28/2019 |
| Last Update Date | 10/28/2019 |
| Medicare PECOS PAC ID | 5193158418 |
|---|---|
| Medicare Enrollment ID | O20191127000724 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801439302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian Grantham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437356326 PECOS PAC ID: 8426102526 Enrollment ID: I20090824000238 |
| Provider Name | Kelley A Hinely |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619395811 PECOS PAC ID: 4284959693 Enrollment ID: I20150205002200 |
| Provider Name | Melody R Mcguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669855912 PECOS PAC ID: 6901113349 Enrollment ID: I20151107000049 |
| Provider Name | Janice Lynn Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235629130 PECOS PAC ID: 4981953791 Enrollment ID: I20180827002946 |
| Provider Name | Donna Ann Dansby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528570819 PECOS PAC ID: 9739449638 Enrollment ID: I20190618001119 |
| Provider Name | Christina Metz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669197927 PECOS PAC ID: 1254798671 Enrollment ID: I20230530003460 |
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