MEDICARE: HEALTHSTAT CLINIC

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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1326340944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHSTAT CLINIC

Provider Business Mailing Address
First Line	:	401 W CAPITOL AVE
Second Line	:	3RD FLOOR
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W CAPITOL AVE
Second Line	:	3RD FLOOR
City	:	LITTLE ROCK
State	:	AR
Zip	:	72201-3421
Country	:	US
Telephone Number	:	704-529-6161
Fax Number	:

Authorized Official
Title or Position	:	VP OF CLINIC OPERATIONS
Name	:	MR. TUCKER MCKAY
Credential	:	NP
Telephone Number	:	704-529-6161

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	12/02/2010

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Directions to “HEALTHSTAT CLINIC ” Practice Location

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