# ROUSE FAMILY MEDICAL CLINIC PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275665523
- **Authorized official:** CYNTHIA WESTACOTT (BILLING MANAGER)
- **Authorized official phone:** (479) 443-0500

## Contact information

- **Practice address:** 1306 S PLEASANT ST, SPRINGDALE, AR 72764-6223
- **Practice address phone:** (479) 443-0500
- **Practice address fax:** (833) 449-3362
- **Mailing address:** 1306 S PLEASANT ST, SPRINGDALE, AR 72764-6223
- **Mailing address phone:** (479) 443-0500
- **Mailing address fax:** (833) 449-3362

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | C4405 | AR | Yes |

## Other

- **Enumeration date:** 03/12/2007
- **Last updated:** 02/26/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 012083557 | UHC | AR |
| 05 | — | 106345001 | — | AR |
| 01 | — | 122530000 | QUALCHOICE QC | AR |
| 01 | — | 126089002 | MEDICAID GROUP | AR |