Organization
UROLOGY GROUP OF WESTERN ARKANSAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN LANGE M.D. (PRESIDENT)
(479) 709-7416
Entity
Organization
Contact information
Practice address
5500 ELLSWORTH RD., FORT SMITH, AR 72903-3222
(479) 242-2411
(479) 242-2412
Mailing address
PO BOX 758, FORT SMITH, AR 72902-0758
(479) 709-7416
(479) 709-7417
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154225002
—
AR
05
—
200027500A
—
OK
01
—
5F080
BLUE CROSS
AR
Enumeration date
01/27/2006
Last updated
03/23/2012
Update your record
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