Provider Demographics
NPI:1720012511
Name:MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS
Other - Org Name:OZARK UROLOGY
Other - Org Type:Doing Business As
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 3886
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-3886
Mailing Address - Country:US
Mailing Address - Phone:479-444-8827
Mailing Address - Fax:479-444-7310
Practice Address - Street 1:3336 N FUTRALL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4057
Practice Address - Country:US
Practice Address - Phone:479-444-8827
Practice Address - Fax:479-444-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161879002Medicaid
OK100726870CMedicaid
AR5F590OtherAR BC/BS