Health Lanes LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

HEALTH LANES LLC

Practice address

3790 N Bellafont Blvd Ste 1
Fayetteville, AR 72703-5481

Phone

(479) 439-0777

Fax

(888) 815-1613

NPI assigned

May 13, 2022

Organization subpart

No

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

Authorized official

Name

Thomas B De Miranda, MD

Title

Owner

Phone

(479) 285-1255

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1652400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652400000000",
    "number": "1750028593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3790 N BELLAFONT BLVD STE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035481",
            "telephone_number": "479-439-0777",
            "fax_number": "888-815-1613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3790 N BELLAFONT BLVD STE 1",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727035481",
            "telephone_number": "479-439-0777",
            "fax_number": "888-815-1613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH LANES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-13",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A",
        "authorized_official_last_name": "DE MIRANDA",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "479-285-1255",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; 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.