Healthcare Provider Details

I. General information

NPI: 1528668357
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PARKWAY CIR STE 125
SPRINGDALE AR
72762-6362
US

IV. Provider business mailing address

PO BOX 1523
FAYETTEVILLE AR
72702-1523
US

V. Phone/Fax

Practice location:
  • Phone: 479-442-6266
  • Fax: 479-521-3877
Mailing address:
  • Phone: 479-571-6038
  • Fax: 479-582-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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