Provider Demographics
NPI:1881690238
Name:ENT AND ALLERGY CENTER, PA
Entity Type:Organization
Organization Name:ENT AND ALLERGY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-521-0455
Mailing Address - Street 1:2100 N GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2807
Mailing Address - Country:US
Mailing Address - Phone:479-521-0455
Mailing Address - Fax:479-444-9722
Practice Address - Street 1:2100 N GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2807
Practice Address - Country:US
Practice Address - Phone:479-521-0455
Practice Address - Fax:479-444-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2017-07-17
Deactivation Date:2005-06-21
Deactivation Code:
Reactivation Date:2007-10-16
Provider Licenses
StateLicense IDTaxonomies
ARMC2362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164139002Medicaid
ARMC2362OtherMEDICAL LICENSE
AR5C169Medicare PIN
AR6084740001Medicare NSC