Basic Information
| Provider Information | |||||||||
| NPI: | 1558897595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EPOCH-NWA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 479 | ||||||||
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| City: | BRYANT | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720890479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012463423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5100 W PAULINE WHITAKER PKWY | ||||||||
| Address2: | STE. 110 | ||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727588335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792026658 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 02/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL AND OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3188345225 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.