Healthcare Provider Details

I. General information

NPI: 1114113529
Provider Name (Legal Business Name): P. SCOTT BALLINGER, M.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 E BEEBE CAPPS EXPY
SEARCY AR
72143-6973
US

IV. Provider business mailing address

1907 E BEEBE CAPPS EXPY
SEARCY AR
72143-6973
US

V. Phone/Fax

Practice location:
  • Phone: 501-305-2251
  • Fax: 501-305-2325
Mailing address:
  • Phone: 501-305-2251
  • Fax: 501-305-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberE-2157
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberE-2157
License Number StateAR

VIII. Authorized Official

Name: DR. PHILLIP SCOTT BALLINGER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-305-2251