Provider Demographics
NPI:1730419755
Name:UAMS OUTPATIENT AUDIOLOGY CLINIC
Entity type:Organization
Organization Name:UAMS OUTPATIENT AUDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-686-5940
Mailing Address - Street 1:4301 W MARKHAM ST # 543
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-5940
Mailing Address - Fax:501-686-6844
Practice Address - Street 1:501 JACK STEPHENS DR # 543
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5551
Practice Address - Country:US
Practice Address - Phone:501-686-5940
Practice Address - Fax:501-686-8644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA7261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech