MEDICARE: ARKANSAS UROLOGY CLINIC, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	MC0918	AR

General Provider Information

NPI Number	:	1912032657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS UROLOGY CLINIC, LTD

Provider Business Mailing Address
First Line	:	1150 E MATTHEWS AVE
Second Line	:	SUITE 203
City	:	JONESBORO
State	:	AR
Zip	:	72401-4314
Country	:	US
Telephone Number	:	870-932-8674
Fax Number	:	870-932-2005

Provider Business Practice Location Address
First Line	:	1150 E MATTHEWS AVE
Second Line	:	SUITE 203
City	:	JONESBORO
State	:	AR
Zip	:	72401-4314
Country	:	US
Telephone Number	:	870-932-8674
Fax Number	:	870-932-2005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN MELVIN ALLEN
Credential	:	M.D.
Telephone Number	:	870-932-8674

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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