NPIMap

Organization Active NPI

Fayetteville Plastic Surgery Clinic

Doing business as Plastic Surgery Clinic of Northwest Arkansas

  • Specialist
  • Fayetteville, AR
National Provider Identifier
1538358247
Registry record updated Oct 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
R3739 Issued in AR
Legal business name
FAYETTEVILLE PLASTIC SURGERY CLINIC
Doing business as
Plastic Surgery Clinic of Northwest Arkansas
Practice address
1794 E Joyce Blvd
Suite 1
Fayetteville, AR 72703-5256
Phone
(479) 443-7771
Fax
(479) 443-7790
NPI assigned
Oct 18, 2007
Last updated
Oct 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2007

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

Authorized official

Name
Ms. C Renee Sandlin
Title
Administrator
Phone
(479) 443-7771

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X R3739 AR Primary

Addresses

Primary practice location

1794 E Joyce Blvd
Suite 1
Fayetteville, AR 72703-5256

Mailing address

1794 E Joyce Blvd
Suite 1
Fayetteville, AR 72703-5256
Phone (479) 443-7771

Other names 1

  • Plastic Surgery Clinic of Northwest Arkansas Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1538358247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1794 E JOYCE BLVD",
            "address_2": "SUITE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035256",
            "telephone_number": "479-443-7771",
            "fax_number": "479-443-7790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1794 E JOYCE BLVD",
            "address_2": "SUITE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035256",
            "telephone_number": "479-443-7771",
            "fax_number": "479-443-7790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE PLASTIC SURGERY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "SANDLIN",
        "authorized_official_first_name": "C",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "479-443-7771",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "R3739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plastic Surgery Clinic of Northwest Arkansas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.