# URBAN MEDICAL CLINIC

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

## Provider details

- **NPI number:** 1295030815
- **Authorized official:** ROSS DOUGLAS (BILLING MANAGER)
- **Authorized official phone:** (870) 424-5079

## Contact information

- **Practice address:** 1 WEST CHEROKEE VILLAGE MALL \#12, CHEROKEE VILLAGE, AR 72529
- **Practice address phone:** (870) 257-4110
- **Practice address fax:** (870) 257-4112
- **Mailing address:** PO BOX 310, MOUNTAIN HOME, AR 72654-0310
- **Mailing address phone:** (870) 424-5079
- **Mailing address fax:** (870) 424-8455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | R3890 | AR | Yes |

## Other

- **Enumeration date:** 01/12/2011
- **Last updated:** 04/19/2011