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General NPI Number Information
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NPI Number | 1528017761
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Entity Type | Organization
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Legal Business Name | ADULT MEDICINE CLINIC OF BLYTHEVILLE, P.C.
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 519 N 6TH ST
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-2407
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Country | US
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Telephone | 870-762-5800
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Fax | 870-762-5801
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Provider Business Mailing Address
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Address Line | PO BOX 405
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City | BLYTHEVILLE
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State | AR
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Zip | 72316-0405
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Country | US
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Telephone | 870-762-5800
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Fax | 870-762-5801
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHALENDER MITTAL
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Credential | M.D.
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Telephone | 870-762-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E2710
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License Number State | AR
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