Provider Demographics
NPI:1194876730
Name:WENDY SPANOS, M.D., P.A.
Entity type:Organization
Organization Name:WENDY SPANOS, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPANOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-935-0700
Mailing Address - Street 1:1107 E MATTHEWS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4331
Mailing Address - Country:US
Mailing Address - Phone:870-935-0700
Mailing Address - Fax:870-935-0706
Practice Address - Street 1:1107 E MATTHEWS AVE STE 103
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4331
Practice Address - Country:US
Practice Address - Phone:870-935-0700
Practice Address - Fax:870-935-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163875002Medicaid
AR5F738Medicare UPIN