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General NPI Number Information
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NPI Number | 1326781816
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Entity Type | Organization
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Legal Business Name | POCAHONTAS MEDICAL CLINIC PA
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 400 W 4TH ST
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City | CORNING
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State | AR
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Zip | 72422-2724
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Country | US
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Telephone | 870-892-4467
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Fax | 870-892-4407
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Provider Business Mailing Address
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Address Line | 2901 MEDICAL CENTER DR
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City | POCAHONTAS
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State | AR
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Zip | 72455-9438
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Country | US
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Telephone | 870-892-4467
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Fax | 870-892-4407
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CINDY A MARKUM
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Credential |
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Telephone | 870-892-4467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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