Provider Demographics
NPI:1346319068
Name:EUREKA WALK IN CLINIC PA
Entity Type:Organization
Organization Name:EUREKA WALK IN CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-363-0100
Mailing Address - Street 1:4052 E VAN BUREN STE A
Mailing Address - Street 2:
Mailing Address - City:EUREKA SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72632-9328
Mailing Address - Country:US
Mailing Address - Phone:479-363-0100
Mailing Address - Fax:479-363-0102
Practice Address - Street 1:4052 E VAN BUREN STE A
Practice Address - Street 2:
Practice Address - City:EUREKA SPGS
Practice Address - State:AR
Practice Address - Zip Code:72632-9328
Practice Address - Country:US
Practice Address - Phone:479-363-0100
Practice Address - Fax:479-363-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M289OtherBCBS
B04838OtherMUNICIPAL HEALTH BENEFIT
88733OtherHEALTH PARTNERS
AR5C679Medicare PIN
88733OtherHEALTH PARTNERS