South Ark Ear Nose &Throat Clinic P a
Organization Active NPI Otolaryngology Physician · Pine Bluff, AR
NPI 1356317440 · NPPES record last updated Apr 30, 2019
Key facts
- NPI
- 1356317440
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- MC1312 (AR)
- Legal business name
- SOUTH ARK EAR NOSE &THROAT CLINIC P A
- Practice address
- 1722 W 42ND Ave
Pine Bluff, AR 71603-7008 - Phone
- (870) 535-5719
- Fax
- (870) 536-1963
- NPI assigned
- Feb 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Stephen Donald Shorts, MD
- Title
- President
- Phone
- (870) 535-5719
Other NPIs on the same Medicare enrollment 1
Practitioners 8
-
Jason A Baugh, CRNA
-
Lori E Cole, CRNA
-
Jonathan M Loetscher, CRNA
-
Pamela L. Padgett, CRNA
-
Stephanie Smith, AUD
-
James Suen, MD
-
Son D Tran, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040818000681 | AR | Part B Supplier - Clinic/Group Practice | 3476526351 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment Practice locations: Pine Bluff, AR |
National Provider Directory
Locations
1408 W 43rd Ave
Pine Bluff, AR 71603
Phone (870) 535-5177
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician |
207K00000X | MC1312 | AR | |
| Allergy Physician |
207KA0200X | MC1312 | AR | |
| Otolaryngology Physician |
207Y00000X | MC1312 | AR | Yes |
| Audiologist |
231H00000X | A#283 | AR | |
| Audiologist-Hearing Aid Fitter |
237600000X | A#283 | AR |
Addresses
Primary practice location
1722 W 42ND Ave
Pine Bluff, AR 71603-7008
Mailing address
1722 W 42ND Ave
Pine Bluff, AR 71603-7008
Phone (870) 535-5719
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142932720 | Medicaid | AR | |
| 56924 | Other | AR | ARKANSAS BLUE CROSS BLUE SHIELD |
| 103005702 | Medicaid | AR |
Other providers in Pine Bluff, AR
- Richard Smith
- Sarah Smith
- Stephanie Smith
- Leannah Sneed
- South Ark Ear Nose & Throat Clinic P a
- South Arkansas Cardiology, P.L.L.C.
- South Arkansas Clinic for Women
- South Arkansas Endocrinology
- South Arkansas Gastroenterology Clinic
- South Arkansas Heart & Vascular Associates, P.a.
All providers in Pine Bluff, AR · Otolaryngology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.