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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