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NPI Code Detail

MEDICARE: ANTOONMEDICALCLINIC,PA

MEDICARE: ANTOONMEDICALCLINIC,PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/CenterR3556AR

General Provider Information

NPI Number : 1073916383
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANTOONMEDICALCLINIC,PA
Provider Business Mailing Address
First Line : 218 CHURCH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-2816
Country : US
Telephone Number : 870-533-1300
Fax Number : 870-533-1303
Provider Business Practice Location Address
First Line : 218 CHURCH ST
Second Line :
City : STAMPS
State : AR
Zip : 71860-2816
Country : US
Telephone Number : 870-533-1300
Fax Number : 870-533-1303
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : DR. PATRICK DAVID ANTOON
Credential : MD
Telephone Number : 870-533-1300
Provider Enumeration Date : 09/30/2014
Last Update Date : 09/30/2014

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Directions to “ANTOONMEDICALCLINIC,PA ” Practice Location

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