Healthcare Provider Details

I. General information

NPI: 1720706922
Provider Name (Legal Business Name): NEW BOSTON MEDICAL GROUP LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 FOREST HILLS BLVD STE 131B
BELLA VISTA AR
72715-3086
US

IV. Provider business mailing address

1801 FOREST HILLS BLVD STE 131B
BELLA VISTA AR
72715-3086
US

V. Phone/Fax

Practice location:
  • Phone: 479-445-7906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD STRATTON DOUGLAS
Title or Position: OWNER
Credential:
Phone: 903-278-9054