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General NPI Number Information
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NPI Number | 1962478115
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Entity Type | Organization
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Legal Business Name | SOUTH ARK EAR NOSE & THROAT CLINIC P A
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 4310 S MULBERRY ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7030
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Country | US
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Telephone | 870-535-5177
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Fax | 870-535-7878
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Provider Business Mailing Address
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Address Line | 4310 S MULBERRY ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7030
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Country | US
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Telephone | 870-535-5177
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Fax | 870-535-7878
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHEN DONALD SHORTS
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Credential | MD
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Telephone | 870-535-5177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 850
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License Number State | AR
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