=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295718211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THUSHA NATHAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2005
-----------------------------------------------------
Last Update Date | 06/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2708 RIFE MEDICAL LANE, SUITE 300
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-338-3030
-----------------------------------------------------
Fax | 479-338-3079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2708 RIFE MEDICAL LN SUITE 300
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-1452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-338-3030
-----------------------------------------------------
Fax | 479-338-3079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | E-7469
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------