Provider Demographics
NPI:1710225099
Name:MATERNITY CENTER OF NORTHWEST ARKANSAS LLC
Entity Type:Organization
Organization Name:MATERNITY CENTER OF NORTHWEST ARKANSAS LLC
Other - Org Name:MATERNITY CENTER OF NORTHWEST ARKANSAS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-372-4560
Mailing Address - Street 1:2000 S PROMENADE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8609
Mailing Address - Country:US
Mailing Address - Phone:479-282-2737
Mailing Address - Fax:877-671-7762
Practice Address - Street 1:5302 W VILLAGE PKWY STE 3
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8139
Practice Address - Country:US
Practice Address - Phone:479-372-4560
Practice Address - Fax:877-461-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty