Organization
PEDIATRIC PARTNERS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON R HENDRICKSON MD (PRESIDENT)
(479) 478-7200
Entity
Organization
Contact information
Practice address
7303 ROGERS AVE, FORT SMITH, AR 72903-4112
(479) 478-7200
(479) 478-7225
Mailing address
PO BOX 11017, FORT SMITH, AR 72917-1017
(479) 478-7200
(479) 478-7225
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MC2365
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F086
BLUE CROSS & BLUE SHIELD
AR
Enumeration date
03/21/2006
Last updated
08/22/2020
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