Healthcare Provider Details

I. General information

NPI: 1457387052
Provider Name (Legal Business Name): ARKANSAS CENTER FOR EAR NOSE THROAT & ALLERGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 PHOENIX AVE
FORT SMITH AR
72903-5091
US

IV. Provider business mailing address

7805 PHOENIX AVE
FORT SMITH AR
72903-5091
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-4220
  • Fax: 479-242-4221
Mailing address:
  • Phone: 479-242-4220
  • Fax: 479-242-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL A MARSH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 479-242-4220