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General NPI Number Information
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NPI Number | 1932174158
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE CLINIC
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 12/15/2009
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Provider Practice Location Address
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Address Line | 1500 MCLAIN ST
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City | NEWPORT
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State | AR
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Zip | 72112-3638
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Country | US
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Telephone | 870-523-9337
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Fax | 870-217-0312
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Provider Business Mailing Address
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Address Line | PO BOX 786
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City | NEWPORT
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State | AR
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Zip | 72112-0786
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Country | US
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Telephone | 870-523-9337
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Fax | 870-217-0312
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. CAROL VIRGINIA RILEY
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Credential | MS
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Telephone | 870-523-9337
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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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