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Organization

THE PEDIATRIC CLINIC OF NLR, P.A.

Active
Other names
The Pediatric Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
TONYA SIMS RN (ADMINISTRATOR)
(501) 758-1530
Entity
Organization

Contact information

Practice address
1525 COUNTRY CLUB RD, SHERWOOD, AR 72120-5076
(501) 758-1530
(501) 819-6171
Mailing address
1525 COUNTRY CLUB RD, SHERWOOD, AR 72120-5076
(501) 758-1530
(501) 819-6171

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104480002
AR
05
200077770A
OK
01
56918
BLUCROSS BLUSHIELD AR
AR
Enumeration date
06/30/2006
Last updated
08/05/2021
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