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General NPI Number Information
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NPI Number | 1083989040
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Entity Type | Organization
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Legal Business Name | MORRILTON MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 10 HOSPITAL DR
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City | MORRILTON
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State | AR
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Zip | 72110-4510
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Country | US
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Telephone | 501-354-0052
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Fax | 501-354-9142
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Provider Business Mailing Address
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Address Line | 10 HOSPITAL DR
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City | MORRILTON
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State | AR
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Zip | 72110-4510
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Country | US
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Telephone | 501-354-0052
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Fax | 501-354-9142
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARK HOELZEMAN
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Credential |
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Telephone | 501-354-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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