Ozark Dermatology Clinic

LBN: Ozark Dermatology Clinic
Ozark Dermatology Clinic is an health care organization with primary practice located at 4375 N. Vantage Drive Suite 305, Fayetteville AR 72703-4984. The organization recently has only one registered license in Other Service Providers / Specialist, which is considered as the primary health care specialty. Ozark Dermatology Clinic can be contacted via phone (479) 443-5100, or through Williams, Diane via phone (479) 335-1831.

Contact Information

Primary practice address
4375 N. Vantage Drive Suite 305 Fayetteville AR 72703-4984
Phone: (479) 443-5100
Fax: (479) 443-5117
Website:
Map and Directions
Authorized official contact:
Name: Williams, Diane
Phone: (479) 335-1831

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X

Profile Details

NPI number 1134207483
LBN Legal business name Ozark Dermatology Clinic
DBA Doing business as
Authorized official Williams, Diane
Entity Organization
Organization subpart 1 No
Enumeration date Nov 2nd, 2006
Last updated Feb 22nd, 2022 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134207483 NPPES
Arkansas Other 7897701 AETNA
Arkansas MEDICAID 14568002 AETNA

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