Provider Demographics
NPI:1447036108
Name:ARKANSAS LUNG CENTER PLLC
Entity type:Organization
Organization Name:ARKANSAS LUNG CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:FASANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-885-1792
Mailing Address - Street 1:4300 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904-7028
Mailing Address - Country:US
Mailing Address - Phone:479-208-4601
Mailing Address - Fax:479-401-2643
Practice Address - Street 1:4300 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-7028
Practice Address - Country:US
Practice Address - Phone:816-885-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty