Healthcare Provider Details

I. General information

NPI: 1235624875
Provider Name (Legal Business Name): CLINTON BUTLER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 HIGHWAY 65 S
CLINTON AR
72031-6657
US

IV. Provider business mailing address

2526 HIGHWAY 65 S
CLINTON AR
72031-6657
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-3784
  • Fax: 501-745-8282
Mailing address:
  • Phone: 501-745-3784
  • Fax: 501-745-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberMG01810
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberMG01810
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberMG01810
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG01810
License Number StateAR

VIII. Authorized Official

Name: DR. MICHAEL BUTLER
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 479-783-5171