Provider Demographics
NPI:1629595566
Name:IMPACT HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:IMPACT HEALTH SERVICES, PLLC
Other - Org Name:NUCOR ARKANSAS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-445-6684
Mailing Address - Street 1:1746 LANNOM DR
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2998
Mailing Address - Country:US
Mailing Address - Phone:731-287-7647
Mailing Address - Fax:731-285-5232
Practice Address - Street 1:5027 N COUNTY ROAD 1015
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-6951
Practice Address - Country:US
Practice Address - Phone:870-824-6538
Practice Address - Fax:870-824-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty