MEDICARE: DOC'S CLINIC AND INSTITUTE, PLC

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	261QH0100X	Health Service Clinic/Center	C-5922	AR

General Provider Information

NPI Number	:	1871622621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOC'S CLINIC AND INSTITUTE, PLC

Provider Business Mailing Address
First Line	:	4220 N CROSSOVER RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4593
Country	:	US
Telephone Number	:	479-251-1552
Fax Number	:	479-251-8956

Provider Business Practice Location Address
First Line	:	4220 N CROSSOVER RD
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-4593
Country	:	US
Telephone Number	:	479-251-1552
Fax Number	:	479-251-8956

Authorized Official
Title or Position	:	FAMILY PRACTICE PHYSICIAN
Name	:	RANDALL BENJAMIN OATES
Credential	:	M.D.
Telephone Number	:	479-251-1552

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/22/2020

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