Provider Demographics
NPI:1598356982
Name:SPRING RIVER CLINIC, LLC
Entity Type:Organization
Organization Name:SPRING RIVER CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERYDON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-534-4917
Mailing Address - Street 1:2803 SPARROW HAWK LN
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1486
Mailing Address - Country:US
Mailing Address - Phone:423-534-4917
Mailing Address - Fax:
Practice Address - Street 1:201 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:IMBODEN
Practice Address - State:AR
Practice Address - Zip Code:72434-9160
Practice Address - Country:US
Practice Address - Phone:423-534-4917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty