Healthcare Provider Details

I. General information

NPI: 1023028016
Provider Name (Legal Business Name): SPAVINAW CLINICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 N. MAIN STREET
DECATUR AR
72722-0735
US

IV. Provider business mailing address

PO BOX 735
DECATUR AR
72722-0735
US

V. Phone/Fax

Practice location:
  • Phone: 479-752-3232
  • Fax: 479-752-3235
Mailing address:
  • Phone: 479-752-3233
  • Fax: 479-752-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PEGGY A BEAL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 479-752-3233