Healthcare Provider Details

I. General information

NPI: 1154906162
Provider Name (Legal Business Name): MITCHELL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HIGHWAY 71 N
DE QUEEN AR
71832-3706
US

IV. Provider business mailing address

PO BOX 345
HORATIO AR
71842-0345
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-8818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES KEITH MITCHELL
Title or Position: EMPLOYER
Credential: MD
Phone: 870-642-8818