Organization
NE ARKANSAS OTOLARYNGOLOGY FACIAL SURGERY P A
Active
Organization
NE ARKANSAS OTOLARYNGOLOGY FACIAL SURGERY P A
Active
Other names
Otolaryngology and Facial Surgery Centre
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROSIE YOUNG (OFFICE MANAGER)
(870) 932-6799
Entity
Organization
Contact information
Practice address
621 E MATTHEWS AVE, JONESBORO, AR 72401-3145
(870) 932-6799
(870) 932-8423
Mailing address
621 E MATTHEWS AVE, JONESBORO, AR 72401-3145
(870) 932-6799
(870) 932-8423
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101792002
—
AR
01
—
57432
BCBS OF AR PROVIDER NUMBE
AR
01
—
CK6516
RAILRAOD MEDICARE
—
Enumeration date
03/16/2006
Last updated
01/23/2020
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