Waldron Place Pediatric Clinic, Inc
Organization Active NPI Clinic/Center · Fort Smith, AR
NPI 1013047356 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1013047356
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- C-5393 (AR)
- Legal business name
- WALDRON PLACE PEDIATRIC CLINIC, INC
- Practice address
- 1501 S Waldron Rd Ste 202
Fort Smith, AR 72903-2598 - Phone
- (479) 452-8311
- Fax
- (479) 452-5032
- NPI assigned
- Mar 6, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Federico Carlos De Miranda, M.D.
- Title
- Owner
- Phone
- (479) 452-8311
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | C-5393 | AR | Yes |
Addresses
Primary practice location
1501 S Waldron Rd Ste 202
Fort Smith, AR 72903-2598
Mailing address
1501 S Waldron Rd Ste 202
Fort Smith, AR 72903-2598
Phone (479) 452-8311
Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.