Organization
EMERGENCY MEDICINE OF NORTHWEST ARKANSAS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF M AUDIBERT M.D. (MANAGER)
(479) 633-4102
Entity
Organization
Contact information
Practice address
3873 NORTH PARKVIEW DRIVE, FAYETTEVILLE, AR 72703
(479) 466-0432
Mailing address
3873 NORTH PARKVIEW DRIVE, FAYETTEVILLE, AR 72703
(479) 466-0432
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
AR
207P00000X
Emergency Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183700002
—
AR
01
—
5G278
ARKANSAS BLUE CROSS
AR
Enumeration date
04/22/2010
Last updated
11/18/2016
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