Provider Demographics
NPI:1225196934
Name:CARUTHERS & WOLVERTON PLLC
Entity Type:Organization
Organization Name:CARUTHERS & WOLVERTON PLLC
Other - Org Name:SOUTHWEST LITTLE ROCK MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CARUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-562-1463
Mailing Address - Street 1:6924 GEYER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209
Mailing Address - Country:US
Mailing Address - Phone:501-562-1463
Mailing Address - Fax:501-562-2702
Practice Address - Street 1:6924 GEYER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209
Practice Address - Country:US
Practice Address - Phone:501-562-1463
Practice Address - Fax:501-562-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN6021207QA0505X
AZN6021208000000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D05018Medicare UPIN
C67962Medicare UPIN
50919Medicare ID - Type UnspecifiedC
55791Medicare ID - Type UnspecifiedW