| Lance L Hamilton M.d. | |
|
2618 Se J Street Ste 12 Bentonville AR 72712 | |
| (479) 715-6505 | |
| (479) 340-0015 |
| Full Name | Lance L Hamilton M.d. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2618 Se J Street, Bentonville, Arkansas |
| Authorized Official Name and Position | Lance Lee Hamilton (OWNER) |
| Authorized Official Contact | 4794146283 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lance L Hamilton M.d. 2618 Se J Street Ste 12 Bentonville AR 72712 Ph: (479) 715-6505 | Lance L Hamilton M.d. 2618 Se J Street Ste 12 Bentonville AR 72712 Ph: (479) 715-6505 |
| NPI Number | 1861859704 |
|---|---|
| Provider Enumeration Date | 01/22/2016 |
| Last Update Date | 08/16/2016 |
| Medicare PECOS PAC ID | 2567754377 |
|---|---|
| Medicare Enrollment ID | O20160817000511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861859704 | NPI | - | NPPES |
| 100125440A | Medicaid | OK | |
| 121148801 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | N8166 (Arkansas) | Primary |
| Provider Name | Samantha A Shepherd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144334343 PECOS PAC ID: 1254316433 Enrollment ID: I20040622000566 |
| Provider Name | Lance Lee Hamilton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053309898 PECOS PAC ID: 1658356456 Enrollment ID: I20040623001498 |
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