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General NPI Number Information
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NPI Number | 1760736565
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Entity Type | Organization
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Legal Business Name | HEALTH FOR LIFE CLINIC PLLC
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 10/31/2012
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Provider Practice Location Address
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Address Line | 1100 N UNIVERSITY AVE STE 260
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City | LITTLE ROCK
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State | AR
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Zip | 72207-6343
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Country | US
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Telephone | 501-603-0003
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Fax | 501-603-0030
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Provider Business Mailing Address
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Address Line | 1100 N UNIVERSITY AVE STE 260
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City | LITTLE ROCK
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State | AR
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Zip | 72207-6343
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Country | US
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Telephone | 501-603-0003
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Fax | 501-603-0030
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Authorized Official
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Title or Position | BILLING ADMINISTRATOR
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Name | TIA PROCTOR
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Credential |
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Telephone | 501-603-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C4604
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License Number State | AR
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