Organization Name: | WK BRADLEY HEALTH CLINIC |
NPI Number: | 1407960271 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREG J GAVIN (NETWORK ADMINISTRATOR) |
Mailing Address: | 409 Woodruff St Bradley |
State: | AR US |
Postal Code: | 71826 |
Phone Number: | 8708943366 |
Fax Number: | 8708943760 |
NPI Enumeration Date: | 08/18/2006 |
NPI Last Update Date: | 07/26/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |