Provider Demographics
NPI:1265548309
Name:MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS LLC
Entity type:Organization
Organization Name:MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PIRTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-563-6504
Mailing Address - Street 1:602 W UNION AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-3014
Mailing Address - Country:US
Mailing Address - Phone:870-563-6504
Mailing Address - Fax:870-563-7482
Practice Address - Street 1:602 W UNION AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3014
Practice Address - Country:US
Practice Address - Phone:870-563-6504
Practice Address - Fax:870-563-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C654Medicare PIN