=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275665523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROUSE FAMILY MEDICAL CLINIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2007
-----------------------------------------------------
Last Update Date | 12/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1306 S PLEASANT ST
-----------------------------------------------------
City | SPRINGDALE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72764-6223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-443-0500
-----------------------------------------------------
Fax | 479-521-3832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1306 S PLEASANT ST
-----------------------------------------------------
City | SPRINGDALE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72764-6223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-443-0500
-----------------------------------------------------
Fax | 833-449-3362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO ROUSE FAMILY MEDICAL CLINIC PA
-----------------------------------------------------
Name | DR. JOE P ROUSE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 479-443-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | C4405
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------