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OZARK DERMATOLOGY CLINIC NPI 1134207483


NPI Information

NPI: 1134207483
Provider Name: OZARK DERMATOLOGY CLINIC
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 04D2186973

Address:
4375 N. VANTAGE DRIVE
SUITE 305
FAYETTEVILLE, AR
ZIP 72703
Phone: (479) 443-5100
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OZARK DERMATOLOGY CLINIC is a specialist in Fayetteville, AR. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. OZARK DERMATOLOGY CLINIC NPI is 1134207483. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4375 N. VANTAGE DRIVE
SUITE 305
FAYETTEVILLE, AR
ZIP 72703-984
Phone: (479) 443-5100
Fax: (479) 443-5117

The provider's authorized official is Diane Williams .
The authorized official title is Credentialing Manager and has the following contact phone number (479) 335-1831.

The CLIA number assigned to this NPI record is 04D2186973 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/2/2006 and was last updated on 2/22/2022.


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
1174400000XSpecialistYes

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
114568002MEDICAIDARKANSAS
27897701OTHERARKANSASAETNA

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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.