Healthcare Provider Details

I. General information

NPI: 1760058895
Provider Name (Legal Business Name): UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 DAVE WARD DR STE 101
CONWAY AR
72034-8679
US

IV. Provider business mailing address

2425 DAVE WARD DR STE 1101
CONWAY AR
72034-8686
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-7600
  • Fax: 501-932-7603
Mailing address:
  • Phone: 501-932-7600
  • Fax: 501-932-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA D GEORGE
Title or Position: VICE CHANCELLOR-CHIEF FINANCIAL OFF
Credential:
Phone: 501-686-5670