# CORE MED PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295590453
- **Authorized official:** DR. RYAN HASENCLEVER (OWNER)
- **Authorized official phone:** (479) 876-8628

## Contact information

- **Practice address:** 902B S WALTON BLVD STE 18, BENTONVILLE, AR 72712-5770
- **Practice address phone:** (479) 876-8628
- **Practice address fax:** (479) 876-8643
- **Mailing address:** 902B S WALTON BLVD STE 18, BENTONVILLE, AR 72712-5770
- **Mailing address phone:** (479) 876-8628
- **Mailing address fax:** (479) 876-8643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/16/2024
- **Last updated:** 05/23/2025