Organization
CRESTWOOD FOOT CLINIC LLC
Active
Organization
CRESTWOOD FOOT CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTHA A JACKSON DPM (OWNER)
(501) 771-4785
Entity
Organization
Contact information
Practice address
2501 CRESTWOOD RD, SUITE 101, NORTH LITTLE ROCK, AR 72116
(501) 771-4785
(501) 771-4787
Mailing address
2501 CRESTWOOD RD, SUITE 101, NORTH LITTLE ROCK, AR 72116-6864
(501) 771-4785
(501) 771-4787
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
87
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161125716
—
AR
01
—
5659610001
DMERC
AR
Enumeration date
06/25/2008
Last updated
07/14/2020
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