1497346407 NPI number — KELAMIS PLASTIC SURGERY, PLLC

Table of content: (NPI 1497346407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497346407 NPI number — KELAMIS PLASTIC SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELAMIS PLASTIC SURGERY, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497346407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2905 N ROM ORCHARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72703-4679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-316-3430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 GRANT PLACE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72703-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-935-3227
Provider Business Practice Location Address Fax Number:
833-927-2540
Provider Enumeration Date:
02/02/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KELAMIS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
PLASTIC SURGEON/OWNER
Authorized Official Telephone Number:
918-408-3549

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 209751001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 425716AD6D . This is a "MEDICARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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