Healthcare Provider Details

I. General information

NPI: 1255432902
Provider Name (Legal Business Name): NORTH ARKANSAS EAR NOSE AND THROAT PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N PINE ST
HARRISON AR
72601-3442
US

IV. Provider business mailing address

PO BOX 1120
HARRISON AR
72602-1120
US

V. Phone/Fax

Practice location:
  • Phone: 870-743-9373
  • Fax: 870-743-9131
Mailing address:
  • Phone: 870-743-9373
  • Fax: 870-743-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMC1976
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberMC1976
License Number StateAR

VIII. Authorized Official

Name: MRS. PAMELA MCGARRAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 870-743-9373