Provider Demographics
NPI:1902147689
Name:NWA ADVANCED MEDICINE P.A.
Entity Type:Organization
Organization Name:NWA ADVANCED MEDICINE P.A.
Other - Org Name:ADVANCED HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUTSONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-571-2273
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-0698
Mailing Address - Country:US
Mailing Address - Phone:479-571-2273
Mailing Address - Fax:
Practice Address - Street 1:2035 N COLLEGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2613
Practice Address - Country:US
Practice Address - Phone:479-571-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4245204D00000X, 207T00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty