Provider Demographics
NPI:1215107008
Name:FORT SMITH RADIATION ONCOLOGY
Entity type:Organization
Organization Name:FORT SMITH RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-648-1800
Mailing Address - Street 1:PO BOX 5710
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72913-5710
Mailing Address - Country:US
Mailing Address - Phone:479-648-1800
Mailing Address - Fax:479-434-5899
Practice Address - Street 1:8500 S 36TH TER
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8880
Practice Address - Country:US
Practice Address - Phone:479-648-1800
Practice Address - Fax:479-434-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE15332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100727970AMedicaid
AR137035002Medicaid