Healthcare Provider Details

I. General information

NPI: 1114482379
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3344 N FUTRALL DR STE B
FAYETTEVILLE AR
72703-4057
US

IV. Provider business mailing address

PO BOX 1523
FAYETTEVILLE AR
72702-1523
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-8200
  • Fax: 479-582-7310
Mailing address:
  • Phone: 479-571-6038
  • Fax: 479-582-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRY HURT
Title or Position: CFO
Credential:
Phone: 479-571-6780