# OTTER CREEK FAMILY CLINIC PLLC

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

## Provider details

- **NPI number:** 1336122340
- **Authorized official:** MISS RITA A ALEXANDER (BILLING COORDINATOR)
- **Authorized official phone:** (501) 455-1331

## Contact information

- **Practice address:** 11321 INTERSTATE 30, STE 101, LITTLE ROCK, AR 72209-7059
- **Practice address phone:** (501) 455-1331
- **Practice address fax:** (501) 455-5597
- **Mailing address:** 11321 INTERSTATE 30, STE 101, LITTLE ROCK, AR 72209-7059
- **Mailing address phone:** (501) 455-1331
- **Mailing address fax:** (501) 455-5597

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | C5502 | AR | Yes |

## Other

- **Enumeration date:** 11/23/2005
- **Last updated:** 06/23/2010