Provider Demographics
NPI:1588822514
Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Entity Type:Organization
Organization Name:UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES
Other - Org Name:NORHTWEST FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:B
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-521-8269
Mailing Address - Street 1:601 W MAPLE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5335
Mailing Address - Country:US
Mailing Address - Phone:479-750-6585
Mailing Address - Fax:479-750-6594
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-750-6585
Practice Address - Fax:479-750-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135072762Medicaid