Provider Demographics
NPI:1487904009
Name:EMERGENCY MEDICINE OF ARKANSAS PLLC
Entity type:Organization
Organization Name:EMERGENCY MEDICINE OF ARKANSAS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-464-0400
Mailing Address - Street 1:1706 SE WALTON BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3200
Mailing Address - Country:US
Mailing Address - Phone:479-464-0400
Mailing Address - Fax:479-268-5688
Practice Address - Street 1:1706 SE WALTON BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3200
Practice Address - Country:US
Practice Address - Phone:479-464-0400
Practice Address - Fax:479-268-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty