Phomakay, Chansamone M
Phomakay, Chansamone M is an individual health care provider with primary practice located at 4700 Kelley Hwy , Fort Smith AR 72904-5024. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Phomakay, Chansamone M can be contacted via phone (479) 573-7990.Contact Information
Primary practice address
4700 Kelley Hwy
Fort Smith AR 72904-5024
Phone: (479) 573-7990
Fax: (479) 573-7991
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | E-6214 | Arkansas |
Profile Details
| NPI number | 1477696284 |
|---|---|
| LBN Legal business name | Phomakay, Chansamone M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 14th, 2007 |
| Last updated | Aug 27th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477696284 | NPPES |
| Oklahoma | MEDICAID | 200232040A | |
| Oklahoma | MEDICAID | 178879001 |
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