Provider Demographics
NPI:1831297167
Name:NORTH ARKANSAS UROLOGY PA
Entity Type:Organization
Organization Name:NORTH ARKANSAS UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-741-2317
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:715 W SHERMAN AVE SUITE A
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602
Mailing Address - Country:US
Mailing Address - Phone:870-841-2317
Mailing Address - Fax:870-741-4090
Practice Address - Street 1:715 W SHERMAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-841-2317
Practice Address - Fax:870-741-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C938Medicare PIN