MEDICARE: OTTER CREEK FAMILY CLINIC PLLC

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	207R00000X	Internal Medicine Physician	C5502	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG8625	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336122340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTER CREEK FAMILY CLINIC PLLC

Provider Business Mailing Address
First Line	:	11321 INTERSTATE 30
Second Line	:	STE 101
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7059
Country	:	US
Telephone Number	:	501-455-1331
Fax Number	:	501-455-5597

Provider Business Practice Location Address
First Line	:	11321 INTERSTATE 30
Second Line	:	STE 101
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7059
Country	:	US
Telephone Number	:	501-455-1331
Fax Number	:	501-455-5597

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	MISS RITA A ALEXANDER
Credential	:
Telephone Number	:	501-455-1331

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	06/23/2010

Similar Medicare Providers

1992764260 — DR. ANIL KUMAR BADHWAR M.D
Practice Location Address:

11321 INTERSTATE 30 , SUITE 308
LITTLE ROCK, AR
72209-7059

Practice Phone: 501-455-7003
Practice Fax: 501-455-7047

1053348870 — DR. STEPHEN SNYDER MD
Practice Location Address:

11321 INTERSTATE 30 , SUITE 101
LITTLE ROCK, AR
72209-7059

Practice Phone: 501-455-1331
Practice Fax: 501-455-5597

1063629244 — MS. LENEE NICOLE RAINEY MHPP
Practice Location Address:

9400 STAGECOACH RD , 1311
LITTLE ROCK, AR
72210-7059

Practice Phone: 501-993-4287
Practice Fax:

1902511397 — HANNAH NICOLE ARMSTRONG OTR/L
Practice Location Address:

17 PARKSTONE CIR # 17
NORTH LITTLE ROCK, AR
72116-7059

Practice Phone: 501-801-9705
Practice Fax:

1760169601 — KATHRYN OSMENT
Practice Location Address:

17 PARKSTONE CIR
NORTH LITTLE ROCK, AR
72116-7059

Practice Phone: 501-801-9705
Practice Fax:

1528748662 — KAYLA MCKINNEY MS, CCC-SLP
Practice Location Address:

17 PARKSTONE CIR
NORTH LITTLE ROCK, AR
72116-7059

Practice Phone: 501-801-9705
Practice Fax:

Directions to “OTTER CREEK FAMILY CLINIC PLLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.