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General NPI Number Information
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NPI Number | 1275618134
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Entity Type | Organization
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Legal Business Name | ARKANSAS VALLEY UROLOGY CLINIC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2501 WEST MAIN STREET
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City | RUSSEVILLE
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State | AR
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Zip | 72801
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Country | US
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Telephone | 479-968-8765
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Fax | 479-967-6501
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Provider Business Mailing Address
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Address Line | 2501 WEST MAIN STREET
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City | RUSSEVILLE
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State | AR
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Zip | 72801
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Country | US
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Telephone | 479-968-8765
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Fax | 479-967-6501
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Authorized Official
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Title or Position | OWNER/UROLOGIST
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Name | CHARLES HUGH BROWN
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Credential |
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Telephone | 479-968-8765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | C4182
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License Number State | AR
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