Provider Demographics
NPI:1205024163
Name:ARD MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:ARD MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-773-3503
Mailing Address - Street 1:566 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2742
Mailing Address - Country:US
Mailing Address - Phone:662-773-3503
Mailing Address - Fax:
Practice Address - Street 1:566 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2742
Practice Address - Country:US
Practice Address - Phone:662-773-3503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care