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General NPI Number Information
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NPI Number | 1417071572
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Entity Type | Organization
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Legal Business Name | MONETTE FAMILY PRACTICE CLINIC PA
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 210 W DREW
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City | MONETTE
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State | AR
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Zip | 72447-0747
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Country | US
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Telephone | 870-486-5464
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Fax | 870-486-2118
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Provider Business Mailing Address
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Address Line | PO BOX 747
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City | MONETTE
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State | AR
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Zip | 72447-0747
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Country | US
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Telephone | 870-486-5464
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Fax | 870-486-2118
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Authorized Official
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Title or Position | BILLING CLERK
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Name | GLEN CHRISTOPHER ROLLAND
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Credential |
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Telephone | 870-486-5464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | S27098
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License Number State | AR
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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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