Provider Demographics
NPI:1376529834
Name:WILLOW STREET HEALTH CENTER, LTD
Entity Type:Organization
Organization Name:WILLOW STREET HEALTH CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DUNAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-741-3252
Mailing Address - Street 1:406 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3517
Mailing Address - Country:US
Mailing Address - Phone:870-741-3252
Mailing Address - Fax:870-741-3962
Practice Address - Street 1:406 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3517
Practice Address - Country:US
Practice Address - Phone:870-741-3252
Practice Address - Fax:870-741-3962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57524Medicare ID - Type Unspecified