Organization
INFECTIOUS DISEASE SPECIALISTS OF NORTHWEST ARKANSAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN HALL HENNIGAN MD (OWNER)
(479) 444-6522
Entity
Organization
Contact information
Practice address
4038 N REMINGTON DR STE 4, FAYETTEVILLE, AR 72703-6314
(479) 444-6522
(479) 444-9426
Mailing address
4038 N REMINGTON DR STE 4, FAYETTEVILLE, AR 72703-6314
(479) 444-6522
(479) 444-9426
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E0104
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125127001
—
AR
01
—
5F046
BLUE CROSS
AR
Enumeration date
10/24/2006
Last updated
04/08/2011
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