Provider Demographics
NPI:1982670113
Name:THE WOMENS CLINIC OF FORREST CITY
Entity Type:Organization
Organization Name:THE WOMENS CLINIC OF FORREST CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEROSSITT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:870-732-5448
Mailing Address - Street 1:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-1687
Mailing Address - Country:US
Mailing Address - Phone:870-732-5448
Mailing Address - Fax:870-732-1734
Practice Address - Street 1:210 S RHODES ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1687
Practice Address - Country:US
Practice Address - Phone:870-732-5448
Practice Address - Fax:870-732-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5392207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B355Medicare ID - Type Unspecified