Provider Demographics
NPI:1326340944
Name:HEALTHSTAT CLINIC
Entity Type:Organization
Organization Name:HEALTHSTAT CLINIC
Other - Org Name:MEDSITE HEALTH MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP OF CLINIC OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TUCKER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:704-529-6161
Mailing Address - Street 1:401 W CAPITOL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-3421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 W CAPITOL AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-3421
Practice Address - Country:US
Practice Address - Phone:704-529-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center