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NORTHWEST DERMATOLOGY CLINIC P.A. NPI 1366490997


NPI Information

NPI: 1366490997
Provider Name: NORTHWEST DERMATOLOGY CLINIC, P.A.
Classification: Dermatology - 207ND0900X
Entity Type: Organization

Specialization: Dermatopathology

Address:
5100 S THOMPSON ST # 212
SPRINGDALE, AR
ZIP 72764
Phone: (479) 750-7200
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NORTHWEST DERMATOLOGY CLINIC, P.A. is a dermatopathology dermatology in Springdale, AR. The provider is a dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. NORTHWEST DERMATOLOGY CLINIC, P.A. NPI is 1366490997. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

5100 S THOMPSON ST # 212
SPRINGDALE, AR
ZIP 72764-933
Phone: (479) 750-7200
Fax: (479) 750-7202

The provider's authorized official is James R Wharton .
The authorized official title is President and has the following contact phone number (479) 750-7200.

The enumeration date for this NPI number is 5/5/2006 and was last updated on 1/6/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatologyMC1781ARKANSASNo
2207ND0101XDermatologyMOHS-Micrographic SurgeryMC1781ARKANSASNo
3207NS0135XDermatologyProcedural DermatologyMC1781ARKANSASNo
4207ND0900XDermatologyDermatopathologyMC1781ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
15C767MEDICARE PINARKANSAS
2133978002MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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