Organization Name: | WILLIS CLINIC EXPRESS |
NPI Number: | 1174959795 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY W WILLIS (MANAGING DIRECTOR) |
Mailing Address: | 616 W Lee Ave Ste 2a Osceola |
State: | AR US |
Postal Code: | 723703002 |
Phone Number: | 8706229212 |
Fax Number: | 8705764350 |
NPI Enumeration Date: | 09/16/2013 |
NPI Last Update Date: | 09/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |