Healthcare Provider Details

I. General information

NPI: 1083989040
Provider Name (Legal Business Name): MORRILTON MEDICAL CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR
MORRILTON AR
72110-4510
US

IV. Provider business mailing address

10 HOSPITAL DR
MORRILTON AR
72110-4510
US

V. Phone/Fax

Practice location:
  • Phone: 501-354-0052
  • Fax: 501-354-9142
Mailing address:
  • Phone: 501-354-0052
  • Fax: 501-354-9142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK HOELZEMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 501-354-0052