Provider Demographics
NPI:1073916383
Name:ANTOONMEDICALCLINIC,PA
Entity Type:Organization
Organization Name:ANTOONMEDICALCLINIC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ANTOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-533-1300
Mailing Address - Street 1:218 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STAMPS
Mailing Address - State:AR
Mailing Address - Zip Code:71860-2816
Mailing Address - Country:US
Mailing Address - Phone:870-533-1300
Mailing Address - Fax:870-533-1303
Practice Address - Street 1:218 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STAMPS
Practice Address - State:AR
Practice Address - Zip Code:71860-2816
Practice Address - Country:US
Practice Address - Phone:870-533-1300
Practice Address - Fax:870-533-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3556261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care