Healthcare Provider Details

I. General information

NPI: 1740480169
Provider Name (Legal Business Name): STUTTGART MEDICAL CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 N MEDICAL DR
STUTTGART AR
72160-3274
US

IV. Provider business mailing address

PO BOX 1901
STUTTGART AR
72160-1901
US

V. Phone/Fax

Practice location:
  • Phone: 870-673-7211
  • Fax: 870-672-6823
Mailing address:
  • Phone: 870-673-3511
  • Fax: 870-672-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LURA WILSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 870-674-6783