R Keith Davis MD PLLC PA
Organization Active NPI Family Medicine Physician · Smackover, AR
NPI 1659604064 · NPPES record last updated Sep 23, 2009
Key facts
- NPI
- 1659604064
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E3055 (AR)
- Legal business name
- R KEITH DAVIS MD PLLC PA
- Practice address
- 1400 Pershing Hwy
Smackover, AR 71762-2300 - Phone
- (870) 725-3471
- Fax
- (870) 725-3215
- NPI assigned
- Sep 16, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Richard K Davis Jr., M.D.
- Title
- Sole Member
- Phone
- (870) 725-3471
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 4
-
R Keith Davis Jr., M.D.
-
Karen Farmer Everett, F.N.P. - B.C.
-
Tanya Marie Golden, NP-C
-
Clinton Avery Netherland, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091006000184 | AR | Part B Supplier - Clinic/Group Practice | 3173669199 |
Receives reassigned benefits from 3 practitioners Practice locations: Smackover, AR |
National Provider Directory
- Tax ID family
- R Keith Davis MD PLLC P
Locations
1400 Pershing Hwy
Smackover, AR 71762
Phone (870) 725-3471
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | E3055 | AR | Yes |
Addresses
Primary practice location
1400 Pershing Hwy
Smackover, AR 71762-2300
Mailing address
PO Box 69
Smackover, AR 71762-0069
Phone (870) 725-3471
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145479001 | Medicaid | AR |
Other providers in Smackover, AR
- Mary Ashley Mathews
- Tamela C Matthews
- Morgan McDaniel
- Clinton Avery Netherland
- R Keith Davis MD PLLC PA
- Renee Landreneau, PLLC
- Richard K Davis MD PLLC PA
- Saffold Therapy. LLC
- Smackover Family Pharmacy, LLC
- Smackover School District
All providers in Smackover, AR · Family Medicine 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 Sep 23, 2009. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.