Provider Demographics
NPI:1164846887
Name:NORTHWEST ARKANSAS BREAST CARE SPECIALISTS, LTD.
Entity type:Organization
Organization Name:NORTHWEST ARKANSAS BREAST CARE SPECIALISTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-971-4630
Mailing Address - Street 1:1317 TOPPING RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1421
Mailing Address - Country:US
Mailing Address - Phone:972-971-4620
Mailing Address - Fax:
Practice Address - Street 1:701 S HORSEBARN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8737
Practice Address - Country:US
Practice Address - Phone:479-202-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8334208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty