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Organization
MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
Active
Organization
MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA
Active
Other names
MANA FM Prairie Grove
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY HURT (CFO)
(479) 571-6780
Entity
Organization
Contact information
Practice address
775 E DOUGLAS ST, PRAIRIE GROVE, AR 72753-2735
(479) 267-5600
(479) 846-5056
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155659002
—
AR
01
—
56750
AR BC/BS
AR
01
—
5B775
AR BLUE CROSS/BLUE SHIELD
AR
Enumeration date
05/12/2006
Last updated
12/15/2025
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