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General NPI Number Information
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NPI Number | 1861518698
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Entity Type | Organization
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Legal Business Name | STUTTGART MEDICAL CLINIC, LTD
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 1609 N MEDICAL DR
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City | STUTTGART
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State | AR
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Zip | 72160-3274
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Country | US
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Telephone | 870-673-7211
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Fax | 870-672-6823
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Provider Business Mailing Address
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Address Line | 1609 N MEDICAL DR
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City | STUTTGART
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State | AR
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Zip | 72160-3274
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Country | US
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Telephone | 870-673-7211
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Fax | 870-672-6823
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | LURA WILSON
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Credential |
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Telephone | 870-674-6783
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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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