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General NPI Number Information
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NPI Number | 1568873586
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Entity Type | Organization
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Legal Business Name | FATHER BOB ALLEN CHARITABLE CLINIC
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 815 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730
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Country | US
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Telephone | 870-864-8010
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Fax | 870-875-1897
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Provider Business Mailing Address
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Address Line | 815 THOMPSON AVE
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City | EL DORADO
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State | AR
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Zip | 71730
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Country | US
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Telephone | 870-864-8010
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Fax | 870-875-1897
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | BRIAN JONES
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Credential |
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Telephone | 870-881-9015
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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 |
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License Number State |
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