Organization
MONETTE FAMILY PRACTICE CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLEN CHRISTOPHER ROLLAND (BILLING CLERK)
(870) 486-5464
Entity
Organization
Contact information
Practice address
210 W DREW, MONETTE, AR 72447-0747
(870) 486-5464
(870) 486-2118
Mailing address
PO BOX 747, MONETTE, AR 72447-0747
(870) 486-5464
(870) 486-2118
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
S27098
AR
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136895762
—
AR
Enumeration date
03/16/2007
Last updated
07/10/2008
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