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Organization
SPARKS MEDICAL FOUNDATION
Active
Organization
SPARKS MEDICAL FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA FRIDDLE (SPARKS PROVIDER RELATIONS MANAGER)
(479) 709-7057
Entity
Organization
Contact information
Practice address
1500 DODSON AVE, FORT SMITH, AR 72901-5182
(479) 709-7399
(479) 709-7053
Mailing address
PO BOX 2420, FORT SMITH, AR 72902-2420
(479) 709-7399
(479) 709-7053
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
207N00000X
Dermatology Physician
—
NULL
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
NULL
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
2083X0100X
Occupational Medicine Physician
—
NULL
2083X0100X
Occupational Medicine Physician
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
2085B0100X
Body Imaging Physician
—
NULL
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
NULL
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
NULL
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
NULL
2085P0229X
Pediatric Radiology Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
291U00000X
Clinical Medical Laboratory
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100706990J
—
OK
05
—
155188002
—
AR
Enumeration date
10/24/2005
Last updated
10/28/2009
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