| Organization Name: | COMMUNITY MEDICAL CLINIC |
| NPI Number: | 1659566719 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAROLYN REBECCA MCCARLEY (APN) |
| Mailing Address: | 8 S Broadview St Suites 5 & 6 Greenbrier |
| State: | AR US |
| Postal Code: | 720589601 |
| Phone Number: | 5015810207 |
| Fax Number: | 5015810209 |
| NPI Enumeration Date: | 09/12/2007 |
| NPI Last Update Date: | 09/12/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | F1104137 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |