# THE SHOT CLINIC, LLC

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

## Provider details

- **NPI number:** 1275960155
- **Authorized official:** FRED E WILSON MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (501) 225-7468

## Contact information

- **Practice address:** 10720 N RODNEY PARHAM RD, SUITE B5, LITTLE ROCK, AR 72212-4177
- **Practice address phone:** (501) 225-7468
- **Practice address fax:** (501) 224-1834
- **Mailing address:** 10720 N RODNEY PARHAM RD, SUITE B5, LITTLE ROCK, AR 72212-4177
- **Mailing address phone:** (501) 225-7468
- **Mailing address fax:** (501) 224-1834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | C-5114 | AR | Yes |

## Other

- **Enumeration date:** 10/09/2013
- **Last updated:** 10/09/2013