Provider Demographics
NPI:1598023285
Name:ECCLES MEDICAL, P.A.
Entity Type:Organization
Organization Name:ECCLES MEDICAL, P.A.
Other - Org Name:ECCLES PEDIATRIC & INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ECCLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-675-3300
Mailing Address - Street 1:67 W MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-3642
Mailing Address - Country:US
Mailing Address - Phone:479-675-3300
Mailing Address - Fax:479-675-3301
Practice Address - Street 1:67 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-3642
Practice Address - Country:US
Practice Address - Phone:479-675-3300
Practice Address - Fax:479-675-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7083207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty