NPIMap

Organization Active NPI

Phoenix Anesthesia PA

  • Anesthesiology Physician
  • Fort Smith, AR
National Provider Identifier
1184889842
Registry record updated May 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PHOENIX ANESTHESIA PA
Practice address
3601 We Knight Dr
Fort Smith, AR 72903-6249
Phone
(479) 709-6702
Fax
(479) 709-6730
NPI assigned
Jul 22, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Teeter, M.D.NPI 1376645317
Title
President
Phone
(479) 785-2555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

3601 We Knight Dr
Fort Smith, AR 72903-6249

Mailing address

PO Box 11286
Fort Smith, AR 72917-1286
Phone (479) 785-2555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081103000083 AR Part B Supplier - Clinic/Group Practice 6901965276 Receives reassigned benefits from 12 practitioners
Practice locations: Fort Smith, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242777600000",
    "number": "1184889842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11286",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729171286",
            "telephone_number": "479-785-2555",
            "fax_number": "479-785-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 WE KNIGHT DR",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729036249",
            "telephone_number": "479-709-6702",
            "fax_number": "479-709-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX ANESTHESIA PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-22",
        "last_updated": "2009-05-20",
        "status": "A",
        "authorized_official_last_name": "TEETER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-785-2555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.