Organization
WADE FALWELL, M.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA K FALWELL (OFFICE MANAGER)
(870) 523-3053
Entity
Organization
Contact information
Practice address
2000 MCLAIN ST, SUITE G, NEWPORT, AR 72112-3661
(870) 523-3053
(870) 523-3637
Mailing address
2000 MCLAIN ST, SUITE G, NEWPORT, AR 72112-3661
(870) 523-3053
(870) 523-3637
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
207Q00000X
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080017871
RAILROAD MEDICARE
AR
05
—
114224001
—
AR
05
—
117464002
—
AR
01
—
1458600000
QUALCHOICE
AR
01
—
50313
ARKANSAS BLUECROSS
AR
Enumeration date
04/09/2007
Last updated
06/20/2012
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