Provider Demographics
NPI:1629047790
Name:BARRON FAMILY PRACTICE CLINIC
Entity Type:Organization
Organization Name:BARRON FAMILY PRACTICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-967-7717
Mailing Address - Street 1:1600 W C PL
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2705
Mailing Address - Country:US
Mailing Address - Phone:479-967-7717
Mailing Address - Fax:479-967-4467
Practice Address - Street 1:1600 W C PL
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2705
Practice Address - Country:US
Practice Address - Phone:479-967-7717
Practice Address - Fax:479-967-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC2352261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care