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General NPI Number Information
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NPI Number | 1205056595
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Entity Type | Organization
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Legal Business Name | THE CLINIC FOR CHILDREN, YOUTH AND YOUNG ADULTS
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 820 MAIN ST S
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City | HOPE
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State | AR
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Zip | 71801
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Country | US
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Telephone | 870-777-7581
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Fax | 870-777-4625
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Provider Business Mailing Address
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Address Line | PO BOX 785
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City | HOPE
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State | AR
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Zip | 71802-0785
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Country | US
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Telephone | 870-777-7581
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Fax | 870-777-4625
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD CRAIG DAVIS
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Credential | M.D.
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Telephone | 870-777-7581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | C5391
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License Number State | AR
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