Provider Demographics
NPI:1518625201
Name:CENTERS MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:CENTERS MEDICAL CLINIC, LLC
Other - Org Name:THE CENTERS MEDICAL CLINIC, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-666-8686
Mailing Address - Street 1:P.O. BOX 251970
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1970
Mailing Address - Country:US
Mailing Address - Phone:501-666-8686
Mailing Address - Fax:501-660-6830
Practice Address - Street 1:1521 MERRILL DRIVE
Practice Address - Street 2:SUITE D240
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1821
Practice Address - Country:US
Practice Address - Phone:501-660-6893
Practice Address - Fax:501-954-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care