Healthcare Provider Details

I. General information

NPI: 1063947604
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 S THOMPSON ST STE C103
SPRINGDALE AR
72764-2558
US

IV. Provider business mailing address

PO BOX 1523
FAYETTEVILLE AR
72702-1523
US

V. Phone/Fax

Practice location:
  • Phone: 479-571-6363
  • Fax: 479-684-3971
Mailing address:
  • Phone: 479-571-6038
  • Fax: 479-582-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMC-2482
License Number StateAR

VIII. Authorized Official

Name: TERRY HURT
Title or Position: CFO
Credential:
Phone: 479-571-6780