Provider Demographics
NPI:1235781733
Name:COMPASSIONATE CARE CLINIC, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:501-279-1512
Mailing Address - Street 1:904 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4653
Mailing Address - Country:US
Mailing Address - Phone:501-279-1512
Mailing Address - Fax:501-325-1912
Practice Address - Street 1:904 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4653
Practice Address - Country:US
Practice Address - Phone:501-279-1512
Practice Address - Fax:501-325-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty