Provider Demographics
NPI:1538296256
Name:THRONEBERRY FAMILY CLINIC, P.A.
Entity Type:Organization
Organization Name:THRONEBERRY FAMILY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BARTON
Authorized Official - Last Name:THRONEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-327-2611
Mailing Address - Street 1:2869 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6087
Mailing Address - Country:US
Mailing Address - Phone:501-327-2611
Mailing Address - Fax:501-336-9763
Practice Address - Street 1:2869 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6087
Practice Address - Country:US
Practice Address - Phone:501-327-2611
Practice Address - Fax:501-336-9763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1741261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARB90620Medicare UPIN
AR55305Medicare ID - Type Unspecified