=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629595566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMPACT HEALTH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2017
-----------------------------------------------------
Last Update Date | 08/22/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5027 N COUNTY ROAD 1015
-----------------------------------------------------
City | BLYTHEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72315-6951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-824-6538
-----------------------------------------------------
Fax | 870-824-6545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1746 LANNOM DR
-----------------------------------------------------
City | DYERSBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38024-2998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-287-7647
-----------------------------------------------------
Fax | 731-285-5232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE OWNER
-----------------------------------------------------
Name | DR. WILLIAM NEIL MCKEE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 731-445-6684
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | E-10353
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------