| Randy S.beallis D.O. P.A. | |
|
7301 Rogers Ave Fl 4 Fort Smith AR 72903-4100 | |
| (479) 646-5700 | |
| (479) 646-5956 |
| Full Name | Randy S.beallis D.O. P.A. |
|---|---|
| Speciality | Family Medicine |
| Location | 7301 Rogers Ave Fl 4, Fort Smith, Arkansas |
| Authorized Official Name and Position | Randy S Beallis (OWNER) |
| Authorized Official Contact | 4794595382 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randy S.beallis D.O. P.A. Po Box 11106 Fort Smith AR 72917-1106 Ph: (479) 459-5382 | Randy S.beallis D.O. P.A. 7301 Rogers Ave Fl 4 Fort Smith AR 72903-4100 Ph: (479) 646-5700 |
| NPI Number | 1447483185 |
|---|---|
| Provider Enumeration Date | 08/28/2009 |
| Last Update Date | 11/04/2021 |
| Certification Date | 11/04/2021 |
| Medicare PECOS PAC ID | 0749335248 |
|---|---|
| Medicare Enrollment ID | O20090908000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447483185 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | MC-2708 (Arkansas) | Primary |
| Provider Name | Randall S Beallis |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1407806623 PECOS PAC ID: 6103888037 Enrollment ID: I20080827000628 |
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