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NPI Code Detail

MEDICARE: BENTON PEDIATRIC CLINIC

MEDICARE: BENTON PEDIATRIC 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
1261QP2300XPrimary Care Clinic/CenterR2391AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
150143OTHERARBLUE CROSS

General Provider Information

NPI Number : 1497753198
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENTON PEDIATRIC CLINIC
Provider Business Mailing Address
First Line : 115 MCNEIL ST
Second Line :
City : BENTON
State : AR
Zip : 72015-3345
Country : US
Telephone Number : 501-315-0421
Fax Number : 501-778-6312
Provider Business Practice Location Address
First Line : 115 MCNEIL ST
Second Line :
City : BENTON
State : AR
Zip : 72015-3345
Country : US
Telephone Number : 501-315-0421
Fax Number : 501-778-6312
Authorized Official
Title or Position : PHYSICIAN
Name : DR. MARY JEWELL ATKINS
Credential : M.D.
Telephone Number : 501-315-0421
Provider Enumeration Date : 07/07/2005
Last Update Date : 08/22/2020

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Directions to “BENTON PEDIATRIC CLINIC ” Practice Location

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