Organization
WESTSIDE FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY BOSOLD (CEO)
(479) 747-2641
Entity
Organization
Contact information
Practice address
3812 W MAIN ST, RUSSELLVILLE, AR 72801-2314
(479) 968-1245
Mailing address
3812 W MAIN ST, RUSSELLVILLE, AR 72801-2314
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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