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Organization
NORTHWEST ARKANSAS PODIATRY CENTER, INC.
Active
Organization
NORTHWEST ARKANSAS PODIATRY CENTER, INC.
Active
Other names
NWA Podiatry Center Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHETSAMONE PETER XAYSANASY DPM (OWNER)
(479) 251-9200
Entity
Organization
Contact information
Practice address
125 W SUNBRIDGE DR, SUITE 1, FAYETTEVILLE, AR 72703-1899
(479) 251-9200
Mailing address
125 W SUNBRIDGE DR, SUITE 1, FAYETTEVILLE, AR 72703-1899
(479) 251-9200
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
193
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146684748
—
AR
01
—
5C648
BLUECROSS BLUESHIELD
AR
Enumeration date
02/15/2007
Last updated
01/03/2011
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