Healthcare Provider Details

I. General information

NPI: 1306814116
Provider Name (Legal Business Name): RUSSELLVILLE EAR NOSE AND THROAT SURGERY CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S INGLEWOOD AVE
RUSSELLVILLE AR
72801-3353
US

IV. Provider business mailing address

106 S INGLEWOOD AVE
RUSSELLVILLE AR
72801-3353
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-5261
  • Fax: 479-968-4761
Mailing address:
  • Phone: 479-968-5261
  • Fax: 479-968-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN F. AUSTIN
Title or Position: OWNER
Credential: M.D.
Phone: 479-968-5261