Organization Name: | WESTERN ARKANSAS PRIMARY CARE |
NPI Number: | 1598186009 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LONNIE J PARKER (PRESIDENT) |
Mailing Address: | 1069 S Sharpe Ave Booneville |
State: | AR US |
Postal Code: | 729274683 |
Phone Number: | 4799658888 |
Fax Number: | 4799658889 |
NPI Enumeration Date: | 12/31/2013 |
NPI Last Update Date: | 12/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | E1887 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |