| Arkansas Lung Center Pllc | |
|
4300 Grand Ave Fort Smith AR 72904-7028 | |
| (479) 208-4601 | |
| (833) 764-3814 |
| Full Name | Arkansas Lung Center Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4300 Grand Ave, Fort Smith, Arkansas |
| Authorized Official Name and Position | Adebayo Fasanya (CEO) |
| Authorized Official Contact | 4792084601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arkansas Lung Center Pllc 4300 Grand Ave Fort Smith AR 72904-7028 Ph: (479) 208-4601 | Arkansas Lung Center Pllc 4300 Grand Ave Fort Smith AR 72904-7028 Ph: (479) 208-4601 |
| NPI Number | 1447036108 |
|---|---|
| Provider Enumeration Date | 09/07/2023 |
| Last Update Date | 04/20/2026 |
| Medicare PECOS PAC ID | 2769838812 |
|---|---|
| Medicare Enrollment ID | O20231025001727 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447036108 | NPI | - | NPPES |
| Provider Name | Adebayo Fasanya |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1508111212 PECOS PAC ID: 1658668827 Enrollment ID: I20180514001589 |
| Provider Name | Soutnakhon Phandanouvong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780273250 PECOS PAC ID: 2163837949 Enrollment ID: I20210209002792 |
| Provider Name | Stephanie N Parish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447951439 PECOS PAC ID: 0547625972 Enrollment ID: I20230508001311 |
| Provider Name | Stephanie Marcom |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730944679 PECOS PAC ID: 5395284426 Enrollment ID: I20240903002563 |
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