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General NPI Number Information
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NPI Number | 1124216700
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Entity Type | Organization
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Legal Business Name | SOUTHWEST ARKANSAS EAR, NOSE & THROAT CLINIC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 100 E 20TH ST STE A
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City | HOPE
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State | AR
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Zip | 71801-8222
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Country | US
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Telephone | 870-722-6200
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Fax | 870-722-2927
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Provider Business Mailing Address
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Address Line | 100 E 20TH ST STE A
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City | HOPE
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State | AR
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Zip | 71801-8222
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Country | US
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Telephone | 870-722-6200
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Fax | 870-722-2927
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | STEPHEN C. SKALESKI
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Credential |
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Telephone | 870-722-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | R2502
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License Number State | AR
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