Provider Demographics
NPI:1083059109
Name:MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-571-6780
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-973-9966
Practice Address - Street 1:3383 N MANA CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4960
Practice Address - Country:US
Practice Address - Phone:479-443-3471
Practice Address - Fax:479-442-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56750Medicare PIN