Provider Demographics
NPI:1215489604
Name:NASSRI PEDIATRICS AND PULMONOLOGY, LLC
Entity type:Organization
Organization Name:NASSRI PEDIATRICS AND PULMONOLOGY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC PULMONOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:NASSRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-221-3732
Mailing Address - Street 1:PO BOX 10718
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0718
Mailing Address - Country:US
Mailing Address - Phone:479-221-3732
Mailing Address - Fax:479-649-8275
Practice Address - Street 1:9207 HIGHWAY 71 S
Practice Address - Street 2:SUITE 9
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9117
Practice Address - Country:US
Practice Address - Phone:479-434-6140
Practice Address - Fax:479-434-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2933261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100045000AMedicaid
AR1881681799OtherNPI
AR105826001Medicaid
AR53822OtherBCBS
OK295507911001OtherBCBS
OK295507911001OtherBCBS