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General NPI Number Information
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NPI Number | 1982816864
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Entity Type | Organization
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Legal Business Name | SCOTT HUSTED MD PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 04/28/2009
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Provider Practice Location Address
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Address Line | 10TH AND HIGHLAND STREET
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City | BLYTHEVILLE
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State | AR
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Zip | 72315
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Country | US
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Telephone | 870-838-7300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | BLYTHEVILLE
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State | AR
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Zip | 72316-0312
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Country | US
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Telephone | 870-838-7300
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BEN CHEATHAM
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Credential |
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Telephone | 901-755-7001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | MC0872
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License Number State | AR
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