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General NPI Number Information
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NPI Number | 1609661305
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Entity Type | Organization
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Legal Business Name | DIVINE MERCY HEALTH CENTER
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 6221 COLONEL GLENN RD STE B
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City | LITTLE ROCK
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State | AR
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Zip | 72204-7731
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Country | US
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Telephone | 501-441-5558
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Fax |
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Provider Business Mailing Address
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Address Line | 6221 COLONEL GLENN RD STE B
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City | LITTLE ROCK
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State | AR
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Zip | 72204-7731
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Country | US
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Telephone | 501-441-5558
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LEE WILBUR
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Credential | MD
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Telephone | 317-409-3019
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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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