Organization Name: | S & R CLINIC, PA |
NPI Number: | 1356480818 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROGER LEE TROXEL (PRESIDENT) |
Mailing Address: | 1045 W Main Suite C Walnut Ridge |
State: | AR US |
Postal Code: | 72476 |
Phone Number: | 8708868300 |
Fax Number: | 8708868302 |
NPI Enumeration Date: | 02/05/2007 |
NPI Last Update Date: | 10/26/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | C8313 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |