Omar Altantawi, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Batesville, AR
NPI 1689310088 · NPPES record last updated May 14, 2024
Key facts
- NPI
- 1689310088
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1710 Harrison St
Batesville, AR 72501-7303 - Phone
- (870) 262-1200
- NPI assigned
- May 9, 2022
- Reactivated
- May 8, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| I20240807003282 | AR | Order and Referring Only - Internal Medicine |
6507303526 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.079467 | IL | MD | Anatomic Pathology & Clinical Pathology Physician |
Interoperability endpoints
- omar.altantawi.1@13831.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 125.079467 | IL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1710 Harrison St
Batesville, AR 72501-7303
Mailing address
1710 Harrison St
Batesville, AR 72501-7303
Phone (870) 262-1200
Other providers in Batesville, AR
- Crystal Allen
- James Davis Allen
- Jana Allen
- Julia L Allen
- Stacey Allen
- Alternative Oppurtunities
- Alternative Oppurtunities
- Alternative Oppurtunities
- Alternative Oppurtunities
- Amedisys Arkansas, L.L.C.
All providers in Batesville, AR · Student in an Organized Health Care Education/Training Program in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2024. 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.