Healthcare Provider Details

I. General information

NPI: 1760718514
Provider Name (Legal Business Name): PREFERRED MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PLAZA WAY SUITE 30
MOUNTAIN HOME AR
72653-9265
US

IV. Provider business mailing address

PO BOX 2368
MOUNTAIN HOME AR
72654-2368
US

V. Phone/Fax

Practice location:
  • Phone: 870-492-9000
  • Fax: 870-492-9003
Mailing address:
  • Phone: 870-492-9000
  • Fax: 870-492-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADAM R WOZNIAK
Title or Position: OWNER
Credential: DO
Phone: 870-492-9000