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General NPI Number Information
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NPI Number | 1578590824
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Entity Type | Organization
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Legal Business Name | NORTHWEST ARKANSAS ALLERGY AND ASTHMA CLINIC
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2109 S 54TH ST STE 2
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City | ROGERS
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State | AR
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Zip | 72758-8195
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Country | US
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Telephone | 479-464-7770
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Fax | 479-464-7772
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Provider Business Mailing Address
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Address Line | 2109 S 54TH ST STE 2
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City | ROGERS
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State | AR
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Zip | 72758-8195
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Country | US
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Telephone | 479-464-7770
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Fax | 479-464-7772
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | HEATHER THOMAS
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Credential |
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Telephone | 479-464-7770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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