Provider Demographics
NPI:1457387052
Name:ARKANSAS CENTER FOR EAR NOSE THROAT & ALLERGY PA
Entity Type:Organization
Organization Name:ARKANSAS CENTER FOR EAR NOSE THROAT & ALLERGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-242-4220
Mailing Address - Street 1:7805 PHOENIX AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5091
Mailing Address - Country:US
Mailing Address - Phone:479-242-4220
Mailing Address - Fax:479-242-4221
Practice Address - Street 1:7805 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5091
Practice Address - Country:US
Practice Address - Phone:479-242-4220
Practice Address - Fax:479-242-4221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C205Medicare ID - Type UnspecifiedARKANSAS MEDICARE NUMBER