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General NPI Number Information
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NPI Number | 1386694933
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Entity Type | Organization
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Legal Business Name | MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 775 E DOUGLAS ST
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City | PRAIRIE GROVE
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State | AR
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Zip | 72753-2735
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Country | US
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Telephone | 479-267-5600
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Fax | 479-846-5056
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Provider Business Mailing Address
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Address Line | PO BOX 1523
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City | FAYETTEVILLE
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State | AR
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Zip | 72702-1523
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Country | US
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Telephone | 479-571-6038
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Fax | 479-582-0222
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Authorized Official
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Title or Position | CFO
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Name | TERRY HURT
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Credential |
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Telephone | 479-571-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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