Central Arkansas Ear Nose & Throat Clinic

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

C7970 Issued in AR

Legal business name

CENTRAL ARKANSAS EAR NOSE & THROAT CLINIC

Practice address

2200 Ada Ave
Ste 202
Conway, AR 72034

Phone

(501) 327-3929

Fax

(501) 329-3816

NPI assigned

Apr 28, 2006

Last updated

Jul 10, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Collie Blevins Shaw, MDNPI 1598763641

Title

Owner President

Phone

(501) 327-3929

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Collie Blevins Shaw, M.D.

  • Otolaryngology Physician
  • Conway, AR
  • NPI 1598763641
  Medicare reassignment Care Compare group NPD Authorized official
• Rafael Jorge Marrero, MD

  • Otolaryngology Physician
  • Conway, AR
  • NPI 1437152329
  Medicare reassignment Care Compare group NPD
• Samuel Cary Kelso, AUD

  • Audiologist-Hearing Aid Fitter
  • Conway, AR
  • NPI 1407001720
  NPD (past)
• Jeffrey P Kirsch, MD

  • Otolaryngology Physician
  • Conway, AR
  • NPI 1801884622
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1093772436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 ADA AVE",
            "address_2": "STE 202",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-327-3929",
            "fax_number": "501-329-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 ADA AVE",
            "address_2": "STE 202",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "72034",
            "telephone_number": "501-327-3929",
            "fax_number": "501-329-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ARKANSAS EAR NOSE & THROAT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "COLLIE",
        "authorized_official_middle_name": "BLEVINS",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "501-327-3929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AR",
            "license": "C7970",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128835002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura L Cecil
• Michelle Celestin
• Centerstone Family Dentistry, PLLC
• Central Arkansas Advanced Nerve and Joint Centers LLC
• Central Arkansas Corf
• Central Arkansas Foot and Ankle Specialist
• Central Arkansas Heart Center
• Central Arkansas OBGYN PLLC
• Central Arkansas Pediatrics, P.a.
• Central Arkansas Sleep Diagnostics, Inc (Dr. Tyrone T. Lee, Conway Pulmonology Clinic)

• Otolaryngology Physician in Conway, AR
• Providers in Conway, AR by specialty
• Otolaryngology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.