Healthcare Provider Details

I. General information

NPI: 1093009292
Provider Name (Legal Business Name): HIGHLANDS ONCOLOGY GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S 52ND ST
ROGERS AR
72758-8602
US

IV. Provider business mailing address

3232 N NORTHHILLS BLVD
FAYETTEVILLE AR
72703-4005
US

V. Phone/Fax

Practice location:
  • Phone: 479-878-1818
  • Fax: 479-878-1819
Mailing address:
  • Phone: 479-587-1700
  • Fax: 479-587-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20654
License Number StateAR

VIII. Authorized Official

Name: TERESA NAGY
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 479-313-6888