Organization
HEALTH FOR LIFE CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIA PROCTOR (BILLING ADMINISTRATOR)
(501) 603-0003
Entity
Organization
Contact information
Practice address
1100 N UNIVERSITY AVE, STE 260, LITTLE ROCK, AR 72207-6343
(501) 603-0003
(501) 603-0030
Mailing address
1100 N UNIVERSITY AVE, STE 260, LITTLE ROCK, AR 72207-6343
(501) 603-0003
(501) 603-0030
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
C4604
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104422001
—
AR
Enumeration date
10/31/2012
Last updated
10/31/2012
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