Organization
RUSSELLVILLE FAMILY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOY A PIKE (BUSINESS MANAGER)
(479) 968-7170
Entity
Organization
Contact information
Practice address
108 SKYLINE DR, RUSSELLVILLE, AR 72801-3362
(479) 968-7170
(479) 968-7607
Mailing address
PO BOX 1648, RUSSELLVILLE, AR 72811-1648
(479) 968-7170
(479) 968-7607
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119926002
—
AR
01
—
8772887600
MEDICARE # ISSUED BY GOVERMENT FOR RAILROAD CLAIMS
AR
Enumeration date
10/14/2005
Last updated
03/11/2014
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