Healthcare Provider Details

I. General information

NPI: 1982816864
Provider Name (Legal Business Name): SCOTT HUSTED MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10TH AND HIGHLAND STREET
BLYTHEVILLE AR
72315
US

IV. Provider business mailing address

PO BOX 312
BLYTHEVILLE AR
72316-0312
US

V. Phone/Fax

Practice location:
  • Phone: 870-838-7300
  • Fax:
Mailing address:
  • Phone: 870-838-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberMC0872
License Number StateAR

VIII. Authorized Official

Name: MR. BEN CHEATHAM
Title or Position: MANAGER
Credential:
Phone: 901-755-7001