Provider Demographics
NPI:1659566719
Name:COMMUNITY MEDICAL CLINIC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:MCCARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:501-581-0207
Mailing Address - Street 1:8 S BROADVIEW
Mailing Address - Street 2:SUITES 5 & 6
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-1169
Mailing Address - Country:US
Mailing Address - Phone:501-581-0207
Mailing Address - Fax:501-581-0209
Practice Address - Street 1:8 S BROADVIEW ST
Practice Address - Street 2:SUITES 5 & 6
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9601
Practice Address - Country:US
Practice Address - Phone:501-581-0207
Practice Address - Fax:501-581-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARF1104137261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care