Provider Demographics
NPI:1053615211
Name:NORTHWEST ARKANSAS INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:NORTHWEST ARKANSAS INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-751-8881
Mailing Address - Street 1:2805 MID CITIES DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4270
Mailing Address - Country:US
Mailing Address - Phone:479-876-8866
Mailing Address - Fax:
Practice Address - Street 1:2805 MID CITIES DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4270
Practice Address - Country:US
Practice Address - Phone:479-876-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty