# HEALTH FOR LIFE CLINIC PLLC

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

## Provider details

- **NPI number:** 1760736565
- **Authorized official:** TIA PROCTOR (BILLING ADMINISTRATOR)
- **Authorized official phone:** (501) 603-0003

## Contact information

- **Practice address:** 1100 N UNIVERSITY AVE, STE 260, LITTLE ROCK, AR 72207-6343
- **Practice address phone:** (501) 603-0003
- **Practice address fax:** (501) 603-0030
- **Mailing address:** 1100 N UNIVERSITY AVE, STE 260, LITTLE ROCK, AR 72207-6343
- **Mailing address phone:** (501) 603-0003
- **Mailing address fax:** (501) 603-0030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | C4604 | AR | Yes |

## Other

- **Enumeration date:** 10/31/2012
- **Last updated:** 10/31/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 104422001 | — | AR |