Provider Demographics
NPI:1659841955
Name:CONNELLEY FAMILY MEDICAL, PLLC
Entity Type:Organization
Organization Name:CONNELLEY FAMILY MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STARTUP COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-723-4921
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71657-0417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 JORDAN DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5719
Practice Address - Country:US
Practice Address - Phone:870-723-4921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty