MEDICARE: VILLAGE PARK MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386696193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE PARK MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 907
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72602-0907
Country	:	US
Telephone Number	:	870-741-7616
Fax Number	:	870-741-7615

Provider Business Practice Location Address
First Line	:	724 N SPRING ST
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-2913
Country	:	US
Telephone Number	:	870-741-7616
Fax Number	:	870-741-7615

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHARRON J LESLIE
Credential	:	M.D.
Telephone Number	:	870-741-7616

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	05/18/2011

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Directions to “VILLAGE PARK MEDICAL CENTER ” Practice Location

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