Provider Demographics
NPI:1205280021
Name:KEYSTONE FAMILY CLINIC
Entity type:Organization
Organization Name:KEYSTONE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-434-6140
Mailing Address - Street 1:11808 HIGHWAY 71 S
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9378
Mailing Address - Country:US
Mailing Address - Phone:479-434-6140
Mailing Address - Fax:479-434-6144
Practice Address - Street 1:11808 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9378
Practice Address - Country:US
Practice Address - Phone:479-434-6140
Practice Address - Fax:479-434-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care