Provider Demographics
NPI:1154536019
Name:ORTHOPAEDIC & SPORTS MEDICINE CLINIC OF NORTHWEST ARKANSAS, P.A.
Entity type:Organization
Organization Name:ORTHOPAEDIC & SPORTS MEDICINE CLINIC OF NORTHWEST ARKANSAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:870-423-3774
Mailing Address - Street 1:408 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4320
Mailing Address - Country:US
Mailing Address - Phone:870-423-3774
Mailing Address - Fax:870-423-4670
Practice Address - Street 1:408 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4320
Practice Address - Country:US
Practice Address - Phone:870-423-3774
Practice Address - Fax:870-423-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0683020001Medicare NSC