Healthcare Provider Details

I. General information

NPI: 1710225099
Provider Name (Legal Business Name): MATERNITY CENTER OF NORTHWEST ARKANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 W VILLAGE PKWY STE 3
ROGERS AR
72758-8139
US

IV. Provider business mailing address

2000 S PROMENADE BLVD STE 202
ROGERS AR
72758-8609
US

V. Phone/Fax

Practice location:
  • Phone: 479-372-4560
  • Fax: 877-461-6743
Mailing address:
  • Phone: 479-282-2737
  • Fax: 877-671-7762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE M SCALLY
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 479-372-4560