Healthcare Provider Details

I. General information

NPI: 1275665523
Provider Name (Legal Business Name): ROUSE FAMILY MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 S PLEASANT ST
SPRINGDALE AR
72764-6223
US

IV. Provider business mailing address

1306 S PLEASANT ST
SPRINGDALE AR
72764-6223
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-0500
  • Fax: 479-521-3832
Mailing address:
  • Phone: 479-443-0500
  • Fax: 833-449-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC4405
License Number StateAR

VIII. Authorized Official

Name: DR. JOE P ROUSE
Title or Position: CEO ROUSE FAMILY MEDICAL CLINIC PA
Credential: MD
Phone: 479-443-0500