Provider Demographics
NPI:1154354157
Name:HEALING ARTS MEDICAL CENTER PA
Entity type:Organization
Organization Name:HEALING ARTS MEDICAL CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:PIECHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-582-1755
Mailing Address - Street 1:4125 E MISSION BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4445
Mailing Address - Country:US
Mailing Address - Phone:479-464-5829
Mailing Address - Fax:479-725-2395
Practice Address - Street 1:4125 E MISSION BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4445
Practice Address - Country:US
Practice Address - Phone:479-582-1755
Practice Address - Fax:479-582-1778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129270002Medicaid
AR129270002Medicaid