Organization
NORTHWEST BENTON COUNTY PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINA MUSIC (DIRECTOR PROVIDER ENROLLMENT)
(877) 892-9815
Entity
Organization
Contact information
Practice address
1102 NW LOWES AVE STE 2, BENTONVILLE, AR 72712-4978
(479) 254-8563
(479) 254-8564
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD6410
RR MEDICARE
AR
Enumeration date
03/23/2006
Last updated
05/08/2025
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