Provider Demographics
NPI:1053828905
Name:MOUNTAIN HOME UROLOGY, P.A.
Entity Type:Organization
Organization Name:MOUNTAIN HOME UROLOGY, P.A.
Other - Org Name:MOUNTAIN HOME UROLOGY, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TEAGUE
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-701-0490
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0910
Mailing Address - Country:US
Mailing Address - Phone:870-701-0490
Mailing Address - Fax:870-701-0491
Practice Address - Street 1:15 GREEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-8102
Practice Address - Country:US
Practice Address - Phone:870-701-0490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-01
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty