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General NPI Number Information
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NPI Number | 1912679549
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Entity Type | Organization
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Legal Business Name | ITI CHITO ENTERPRISES INC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 500 E COLLIN RAYE DR STE 2
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City | DE QUEEN
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State | AR
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Zip | 71832-8068
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Country | US
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Telephone | 870-642-7257
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Fax | 870-642-5015
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Provider Business Mailing Address
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Address Line | 500 E. COLLIN RAYE DRIVE
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City | DE QUEEN
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State | AR
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Zip | 71832-8054
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Country | US
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Telephone | 870-642-7257
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Fax | 870-642-5015
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Authorized Official
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Title or Position | OWNER
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Name | MR. RUSTY LYNN GRIFFIN
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Credential |
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Telephone | 501-765-0275
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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