Provider Demographics
NPI:1306814116
Name:RUSSELLVILLE EAR NOSE AND THROAT SURGERY CLINIC, P.A.
Entity Type:Organization
Organization Name:RUSSELLVILLE EAR NOSE AND THROAT SURGERY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-968-5261
Mailing Address - Street 1:106 S INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3353
Mailing Address - Country:US
Mailing Address - Phone:479-968-5261
Mailing Address - Fax:479-968-4761
Practice Address - Street 1:106 S INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3353
Practice Address - Country:US
Practice Address - Phone:479-968-5261
Practice Address - Fax:479-968-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57789OtherARK. BCBS
AR57789Medicare ID - Type Unspecified