| Donna Beallis D.o. P.a. | |
|
153 E Monte Painter Dr Fayetteville AR 72703-4002 | |
| (479) 444-2200 | |
| (479) 444-2390 |
| Full Name | Donna Beallis D.o. P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 153 E Monte Painter Dr, Fayetteville, Arkansas |
| Authorized Official Name and Position | Donna B Beallis (OWNER) |
| Authorized Official Contact | 4798060647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Donna Beallis D.o. P.a. Po Box 11134 Fort Smith AR 72917-1134 Ph: (479) 285-5497 | Donna Beallis D.o. P.a. 153 E Monte Painter Dr Fayetteville AR 72703-4002 Ph: (479) 444-2200 |
| NPI Number | 1184951998 |
|---|---|
| Provider Enumeration Date | 11/16/2009 |
| Last Update Date | 10/05/2021 |
| Medicare PECOS PAC ID | 2668659897 |
|---|---|
| Medicare Enrollment ID | O20110615000528 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184951998 | NPI | - | NPPES |
| 200199440A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | E-5626 (Arkansas) | Primary |
| Provider Name | Donna B Beallis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669423125 PECOS PAC ID: 5890757736 Enrollment ID: I20080827000615 |
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