Provider Demographics
NPI:1821293051
Name:FORREST CITY CLINIC COMPANY LLC
Entity Type:Organization
Organization Name:FORREST CITY CLINIC COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIRECTOR PHYSICIAN PRACTICE REV
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:1601 NEWCASTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336
Mailing Address - Country:US
Mailing Address - Phone:870-261-0000
Mailing Address - Fax:
Practice Address - Street 1:1601 NEWCASTLE ROAD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72336
Practice Address - Country:US
Practice Address - Phone:870-261-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR166132002Medicaid
AR5F850OtherBCBS
AR5F850OtherBCBS