Healthcare Provider Details

I. General information

NPI: 1134534027
Provider Name (Legal Business Name): SCRIBNER FAMILY PRACTICE CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 TURNER LN
SALEM AR
72576-5600
US

IV. Provider business mailing address

PO BOX 648
SALEM AR
72576-0648
US

V. Phone/Fax

Practice location:
  • Phone: 870-859-3238
  • Fax:
Mailing address:
  • Phone: 870-859-3238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberE3933
License Number StateAR

VIII. Authorized Official

Name: JOHN SCRIBNER
Title or Position: MANAGING EMPLOYEE
Credential: M.D.
Phone: 870-895-3238