NPIMap

Organization Active NPI

Southwest Arkansas Ear, Nose & Throat Clinic

  • Facial Plastic Surgery Physician
  • Hope, AR
National Provider Identifier
1124216700
Registry record updated May 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
License
R2502 Issued in AR
Legal business name
SOUTHWEST ARKANSAS EAR, NOSE & THROAT CLINIC
Practice address
100 E 20TH St Ste a
Hope, AR 71801-8222
Phone
(870) 722-6200
Fax
(870) 722-2927
NPI assigned
Oct 9, 2007
Reactivated
May 13, 2011
Last updated
May 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2011

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

Authorized official

Name
Stephen C. Skaleski
Title
Office Manager
Phone
(870) 722-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery Physician 207YS0123X R2502 AR Primary

Addresses

Primary practice location

100 E 20TH St Ste a
Hope, AR 71801-8222

Mailing address

100 E 20TH St Ste a
Hope, AR 71801-8222
Phone (870) 722-6200

Other identifiers 2

IdentifierTypeStateIssuer
106113001MedicaidAR
55795OtherARBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

100 E 20th St
Ste A
Hope, AR 71801
Phone (870) 722-6200

NPI Registry JSON

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305244800000",
    "number": "1124216700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 20TH ST STE A",
            "city": "HOPE",
            "state": "AR",
            "postal_code": "718018222",
            "telephone_number": "870-722-6200",
            "fax_number": "870-722-2927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E 20TH ST STE A",
            "city": "HOPE",
            "state": "AR",
            "postal_code": "718018222",
            "telephone_number": "870-722-6200",
            "fax_number": "870-722-2927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST ARKANSAS EAR, NOSE & THROAT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2011-05-13",
        "deactivation_date": "2010-07-27",
        "reactivation_date": "2011-05-13",
        "status": "A",
        "authorized_official_last_name": "SKALESKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-722-6200"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "AR",
            "license": "R2502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106113001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "55795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hope, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.