Provider Demographics
NPI:1215219142
Name:COMPREHENSIVE CARE CLINIC
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-588-4164
Mailing Address - Street 1:PO BOX 16413
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72231-6413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7481 WARDEN RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5041
Practice Address - Country:US
Practice Address - Phone:501-588-4164
Practice Address - Fax:501-377-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARH25195Medicare UPIN