Organization
ARKANSAS FOOT CARE CLINIC, INC
Active
Other names
Aquilar Foot Care Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER AQUILAR (ASSISTANT OFFICE MANAGER)
(479) 970-2832
Entity
Organization
Contact information
Practice address
2400 W MAIN ST, RUSSELLVILLE, AR 72801-2531
(479) 890-3668
(479) 890-9513
Mailing address
PO BOX 2089, RUSSELLVILLE, AR 72811-2089
(479) 890-3668
(479) 890-9513
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
AR141
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139915748
—
AR
01
—
5F442
BCBS GROUP NUMBER
AR
01
—
DE6137
RAILROAD MEDICARE NUMBER
AR
Enumeration date
05/24/2005
Last updated
11/30/2011
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