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General NPI Number Information
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NPI Number | 1366422305
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Entity Type | Organization
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Legal Business Name | MONTICELLO MEDICAL CLINIC PLC
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 906 ROBERTS DR
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City | MONTICELLO
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State | AR
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Zip | 71655-5724
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Country | US
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Telephone | 870-367-6867
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Fax | 870-367-1461
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Provider Business Mailing Address
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Address Line | 906 ROBERTS DR
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City | MONTICELLO
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State | AR
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Zip | 71655-5724
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Country | US
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Telephone | 870-367-6867
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Fax | 870-367-1461
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Authorized Official
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Title or Position | PARTNER
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Name | SYLVIA SIMON
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Credential | MD
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Telephone | 870-367-6867
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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