| Organization Name: | MEDICAL ASSOCIATES OF NORTHWEST ARKANSAS PA |
| NPI Number: | 1770534703 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN JORDIN (CIO) |
| Mailing Address: | 63 W Sunbridge Dr Fayetteville |
| State: | AR US |
| Postal Code: | 727031825 |
| Phone Number: | 4795823366 |
| Fax Number: | 4795825843 |
| NPI Enumeration Date: | 05/15/2006 |
| NPI Last Update Date: | 09/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |