Healthcare Provider Details

I. General information

NPI: 1780343210
Provider Name (Legal Business Name): DQH&W WALK IN FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 W COLLIN RAYE DR
DE QUEEN AR
71832-2946
US

IV. Provider business mailing address

1357 W COLLIN RAYE DR
DE QUEEN AR
71832-2946
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-2000
  • Fax:
Mailing address:
  • Phone: 870-642-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHESTER BARBER
Title or Position: OWNER
Credential:
Phone: 870-642-2400