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General NPI Number Information
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NPI Number | 1205280021
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Entity Type | Organization
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Legal Business Name | KEYSTONE FAMILY CLINIC
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 11808 HIGHWAY 71 S
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City | FORT SMITH
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State | AR
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Zip | 72916-9378
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Country | US
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Telephone | 479-434-6140
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Fax | 479-434-6144
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Provider Business Mailing Address
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Address Line | 11808 HIGHWAY 71 S
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City | FORT SMITH
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State | AR
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Zip | 72916-9378
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Country | US
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Telephone | 479-434-6140
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Fax | 479-434-6144
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSHUA AARON CLARK
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Credential | M.D.
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Telephone | 479-434-6140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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