Organization
GREAT RIVER PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN ASAFO-BOAKYE M.D., MPH, FAAP (PEDIATRICIAN)
(870) 780-6832
Entity
Organization
Contact information
Practice address
1521 N 10TH ST, STE F, BLYTHEVILLE, AR 72315-1405
(870) 780-6832
(870) 780-6919
Mailing address
1521 N 10TH ST, STE F, BLYTHEVILLE, AR 72315-1405
(870) 780-6832
(870) 780-6919
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
E-4133
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F511
BLUE CROSS BLUE SHIELD
AR
Enumeration date
03/15/2007
Last updated
08/22/2020
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