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General NPI Number Information
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NPI Number | 1578591129
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Entity Type | Organization
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Legal Business Name | SALEM FAMILY PRACTICE CLINIC,PA
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 6640 CONGO RD
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City | BENTON
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State | AR
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Zip | 72019-6913
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Country | US
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Telephone | 501-794-4110
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Fax | 501-316-9360
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Provider Business Mailing Address
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Address Line | 6640 CONGO RD
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City | BENTON
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State | AR
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Zip | 72019-6913
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Country | US
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Telephone | 501-794-4110
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Fax | 501-316-9360
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. PATRICIA G MCGARRY
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Credential | M.D.
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Telephone | 501-794-4110
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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 | MC1718
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License Number State | AR
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