Healthcare Provider Details

I. General information

NPI: 1952540387
Provider Name (Legal Business Name): MCCLINTOCK FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N CHESTNUT ST
HARRISON AR
72601-4453
US

IV. Provider business mailing address

PO BOX 1497
HARRISON AR
72602-1497
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8559
  • Fax: 870-741-8423
Mailing address:
  • Phone: 870-741-8559
  • Fax: 870-741-8423

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: JACOB NELSON MCCLINTOCK
Title or Position: OWNER
Credential: MD
Phone: 870-741-8559