Organization
MCCRORY FAMILY CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED E WILSON MD (MD)
(870) 731-1100
Entity
Organization
Contact information
Practice address
908 N EDMONDS AVE, MCCRORY, AR 72101
(870) 731-1100
(870) 731-1019
Mailing address
PO BOX 780, MCCRORY, AR 72101
(870) 731-1100
(870) 731-1019
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
MC-1803
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134056002
—
AR
05
—
134474729
—
AR
01
—
CI5031
RAILROAD MEDICARE
AR
Enumeration date
08/30/2006
Last updated
06/09/2008
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