Organization
FONTICIELLA MEDICAL CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADALBERTO RAMON FONTICIELLA M.D. (M.D.)
(870) 236-6930
Entity
Organization
Contact information
Practice address
1000 WEST KINGSHIGHWAY, SUITE 12, PARAGOULD, AR 72450-8894
(870) 236-6930
(870) 239-8065
Mailing address
1000 WEST KINGSHIGHWAY, SUITE 12, PARAGOULD, AR 72450-8894
(870) 236-6930
(870) 239-8065
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C6766
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157456002
—
AR
Enumeration date
07/29/2006
Last updated
08/08/2016
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