Healthcare Provider Details

I. General information

NPI: 1790784734
Provider Name (Legal Business Name): EAR, NOSE & THROAT ASSOCIATES OF MOUNTAIN HOME, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 BURNETT DR
MOUNTAIN HOME AR
72653-2941
US

IV. Provider business mailing address

626 BURNETT DR
MOUNTAIN HOME AR
72653-2941
US

V. Phone/Fax

Practice location:
  • Phone: 870-424-4200
  • Fax: 870-424-4327
Mailing address:
  • Phone: 870-424-4200
  • Fax: 870-424-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number StateAR
# 7
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateAR
# 8
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateAR

VIII. Authorized Official

Name: DR. MONTY BARKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 870-424-4200