Provider Demographics
NPI:1942226212
Name:PHYSICIANS MEDICAL GROUP PLC
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL GROUP PLC
Other - Org Name:STARNES FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:STARNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-745-7161
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0489
Mailing Address - Country:US
Mailing Address - Phone:501-745-7161
Mailing Address - Fax:501-745-8714
Practice Address - Street 1:145 SHAKERAG RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6678
Practice Address - Country:US
Practice Address - Phone:501-745-7161
Practice Address - Fax:501-745-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4237261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168494729Medicaid
AR043832Medicare Oscar/Certification
DD3914Medicare PIN
D27780Medicare UPIN
043832Medicare PIN
AR168494729Medicaid