Provider Demographics
NPI:1114799483
Name:METHENY FAMILY CARE CLINIC CORP
Entity Type:Organization
Organization Name:METHENY FAMILY CARE CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:METHENY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:479-844-4300
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:ELM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72728-0083
Mailing Address - Country:US
Mailing Address - Phone:479-844-4300
Mailing Address - Fax:479-844-4201
Practice Address - Street 1:106 WATER AVE STE A
Practice Address - Street 2:
Practice Address - City:ELM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72762-9155
Practice Address - Country:US
Practice Address - Phone:479-844-4300
Practice Address - Fax:479-844-4201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METHENY FAMILY CARE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center