Kim R Agee, MD
Individual provider Active NPI Pulmonary Disease Physician · Fayetteville, AR
NPI 1003851072 · NPPES record last updated Feb 22, 2008
Key facts
- NPI
- 1003851072
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pulmonary Disease Physician 207RP1001X
- License
- C-6784 (AR)
- Practice address
- 3344 N Futrall Dr
Fayetteville, AR 72703-4057 - Phone
- (479) 521-8200
- Fax
- (479) 582-7310
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140709002024 | AR | Order and Referring Only - Critical Care (Intensivists) |
3274511142 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-6784 | AR | MD | Pulmonary Disease Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | C-6784 | AR | Yes |
Addresses
Primary practice location
3344 N Futrall Dr
Fayetteville, AR 72703-4057
Mailing address
PO Box 1523
Fayetteville, AR 72702-1523
Phone (479) 521-8200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5K140 | Other | AR | AR BC/BS |
| P00192576 | Other | AR | RAILROAD MEDICARE |
Other providers in Fayetteville, AR
- Aell Spencer Chiropractic Inc
- Aftersun Psychotherapy & Healing, LLC
- Joseph Agan
- Noelle R Agan
- Christina Marie Agee
- Clinton L Aguiar
- Brittany N. Aguirre
- Waqas Ahmad
- Zubair Ahmed
- Samantha Aiken
All providers in Fayetteville, AR · Pulmonary Disease Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.