Randy S.beallis D.o. P.a. | |
7301 Rogers Ave Fl 4 Fort Smith AR 72903-4100 | |
(479) 646-5700 | |
(479) 646-5956 |
Full Name | Randy S.beallis D.o. P.a. |
---|---|
Speciality | Family Medicine |
Location | 7301 Rogers Ave Fl 4, Fort Smith, Arkansas |
Authorized Official Name and Position | Randy S Beallis (OWNER) |
Authorized Official Contact | 4794595382 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Randy S.beallis D.o. P.a. Po Box 11106 Fort Smith AR 72917-1106 Ph: (479) 459-5382 | Randy S.beallis D.o. P.a. 7301 Rogers Ave Fl 4 Fort Smith AR 72903-4100 Ph: (479) 646-5700 |
NPI Number | 1447483185 |
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Provider Enumeration Date | 08/28/2009 |
Last Update Date | 11/04/2021 |
Medicare PECOS PAC ID | 0749335248 |
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Medicare Enrollment ID | O20090908000008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447483185 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207QA0505X | Family Medicine - Adult Medicine | MC-2708 (Arkansas) | Primary |
Provider Name | Randall S Beallis |
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Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1407806623 PECOS PAC ID: 6103888037 Enrollment ID: I20080827000628 |
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