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General NPI Number Information
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NPI Number | 1053397554
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Entity Type | Organization
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Legal Business Name | NORTH PULASKI DIAGNOSTIC CLINIC
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2215 WILDWOOD AVE SUITE 201
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City | SHERWOOD
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State | AR
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Zip | 72120-5089
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Country | US
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Telephone | 501-833-8400
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Fax | 501-833-0266
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Provider Business Mailing Address
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Address Line | 2215 WILDWOOD AVE SUITE 201
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City | SHERWOOD
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State | AR
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Zip | 72120-5089
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Country | US
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Telephone | 501-833-8400
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Fax | 501-833-0266
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RUTH HICKMAN
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Credential |
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Telephone | 501-833-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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