Provider Demographics
NPI:1982037016
Name:ASHDOWN MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:ASHDOWN MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:TACKETT
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-898-5037
Mailing Address - Street 1:418 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-2755
Mailing Address - Country:US
Mailing Address - Phone:870-898-5037
Mailing Address - Fax:870-898-3910
Practice Address - Street 1:418 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-2755
Practice Address - Country:US
Practice Address - Phone:870-898-5037
Practice Address - Fax:870-898-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199114762Medicaid
AR5D121Medicare PIN