Organization
FAMILY PRACTICE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL VIRGINIA RILEY MS (OFFICE MANAGER)
(870) 523-9337
Entity
Organization
Contact information
Practice address
1500 MCLAIN ST, NEWPORT, AR 72112-3638
(870) 523-9337
(870) 217-0312
Mailing address
PO BOX 786, NEWPORT, AR 72112-0786
(870) 523-9337
(870) 217-0312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148627002
—
AR
01
—
5C720
MEDICARE PROVIDER NUMBER
AR
Enumeration date
02/21/2006
Last updated
12/15/2009
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