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General NPI Number Information
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NPI Number | 1831150747
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Entity Type | Organization
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Legal Business Name | PRESCOTT FAMILY CLINIC P A
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 301 HALE AVE
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City | PRESCOTT
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State | AR
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Zip | 71857-3330
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Country | US
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Telephone | 870-887-6651
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Fax | 870-887-2008
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Provider Business Mailing Address
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Address Line | 301 HALE AVE
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City | PRESCOTT
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State | AR
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Zip | 71857-3330
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Country | US
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Telephone | 870-887-6651
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Fax | 870-887-2008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL CLARENCE YOUNG
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Credential | M.D.
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Telephone | 870-887-6651
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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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