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Organization

THE SHOT CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FRED E WILSON MD (MEDICAL DIRECTOR)
(501) 225-7468
Entity
Organization

Contact information

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

Taxonomy

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

Other

Enumeration date
10/09/2013
Last updated
10/09/2013
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