Provider Demographics
NPI:1184194409
Name:FALWELL MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:FALWELL MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALWELL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-217-4071
Mailing Address - Street 1:1301 MCLAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3633
Mailing Address - Country:US
Mailing Address - Phone:870-217-4071
Mailing Address - Fax:870-217-4072
Practice Address - Street 1:1301 MCLAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3633
Practice Address - Country:US
Practice Address - Phone:870-217-4071
Practice Address - Fax:870-217-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty