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General NPI Number Information
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NPI Number | 1356480818
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Entity Type | Organization
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Legal Business Name | S & R CLINIC, PA
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 1045 W MAIN SUITE C
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City | WALNUT RIDGE
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State | AR
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Zip | 72476
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Country | US
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Telephone | 870-886-8300
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Fax | 870-886-8302
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Provider Business Mailing Address
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Address Line | PO BOX 777
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City | WALNUT RIDGE
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State | AR
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Zip | 72476-0777
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Country | US
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Telephone | 870-886-8300
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Fax | 870-886-8302
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER LEE TROXEL
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Credential | M.D.
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Telephone | 870-886-8300
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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 | C8313
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License Number State | AR
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