| Bohannan Anesthesia Pllc | |
|
3737 W Walnut St Rogers AR 72756-1839 | |
| (479) 246-1751 | |
| Not Available |
| Full Name | Bohannan Anesthesia Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3737 W Walnut St, Rogers, Arkansas |
| Authorized Official Name and Position | Holly Rae Bohannan (OWNER) |
| Authorized Official Contact | 4795306649 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bohannan Anesthesia Pllc 12688 Miller Church Rd Bentonville AR 72712-9041 Ph: (479) 530-6649 | Bohannan Anesthesia Pllc 3737 W Walnut St Rogers AR 72756-1839 Ph: (479) 246-1751 |
| NPI Number | 1740758366 |
|---|---|
| Provider Enumeration Date | 11/13/2018 |
| Last Update Date | 11/13/2018 |
| Medicare PECOS PAC ID | 4284979402 |
|---|---|
| Medicare Enrollment ID | O20181217001743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740758366 | NPI | - | NPPES |
| 771165401 | Other | AR | AR BREAST CARE |
| 914302906 | Medicaid | MO | |
| 200330120 | Medicaid | OK | |
| 163654001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QS0132X | Clinic/center - Ophthalmologic Surgery | (* (Not Available)) | Primary |
| Provider Name | Holly R Bohannan |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1326097890 PECOS PAC ID: 7113020108 Enrollment ID: I20070312000579 |
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