Provider Demographics
NPI:1396717534
Name:MEDICAL PLAZA UROLOGY ASSOCIATES
Entity type:Organization
Organization Name:MEDICAL PLAZA UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LADD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCRIBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-932-2926
Mailing Address - Street 1:PO BOX 1513
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1513
Mailing Address - Country:US
Mailing Address - Phone:870-932-2926
Mailing Address - Fax:870-932-1560
Practice Address - Street 1:303 E MATTHEWS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3150
Practice Address - Country:US
Practice Address - Phone:870-932-2926
Practice Address - Fax:870-932-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARCH0852OtherRAILROAD MEDICARE
AR101735002Medicaid
AR101735002Medicaid