Organization
OTTER CREEK FAMILY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS RITA A ALEXANDER (BILLING COORDINATOR)
(501) 455-1331
Entity
Organization
Contact information
Practice address
11321 INTERSTATE 30, STE 101, LITTLE ROCK, AR 72209-7059
(501) 455-1331
(501) 455-5597
Mailing address
11321 INTERSTATE 30, STE 101, LITTLE ROCK, AR 72209-7059
(501) 455-1331
(501) 455-5597
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C5502
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140671002
—
AR
01
—
CG8625
RR MEDICARE
—
Enumeration date
11/23/2005
Last updated
06/23/2010
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