# HEALTH LANES LLC

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

## Provider details

- **NPI number:** 1750028593
- **Authorized official:** THOMAS B DE MIRANDA MD (OWNER)
- **Authorized official phone:** (479) 285-1255

## Contact information

- **Practice address:** 3790 N BELLAFONT BLVD STE 1, FAYETTEVILLE, AR 72703-5481
- **Practice address phone:** (479) 439-0777
- **Practice address fax:** (888) 815-1613
- **Mailing address:** 3790 N BELLAFONT BLVD STE 1, FAYETTEVILLE, AR 72703-5481
- **Mailing address phone:** (479) 439-0777
- **Mailing address fax:** (888) 815-1613

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/13/2022
- **Last updated:** 05/13/2022