Healthcare Provider Details

I. General information

NPI: 1669130464
Provider Name (Legal Business Name): CARRIAGE HILL FAMILY CARE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 11/26/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 CARRIAGE HILL DR STE B
PARAGOULD AR
72450-5329
US

IV. Provider business mailing address

3501 CARRIAGE HILL DR STE B
PARAGOULD AR
72450-5329
US

V. Phone/Fax

Practice location:
  • Phone: 870-573-2200
  • Fax: 870-573-2300
Mailing address:
  • Phone: 870-573-2200
  • Fax: 870-573-2300

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. VINCENT G LEE
Title or Position: OWNER
Credential: MD
Phone: 870-573-2200