Provider Demographics
NPI:1740317452
Name:LAWRENCE COUNTY FAMILY CLINIC, PA
Entity type:Organization
Organization Name:LAWRENCE COUNTY FAMILY CLINIC, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-886-3543
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:WALNUT RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72476-0719
Mailing Address - Country:US
Mailing Address - Phone:870-886-3543
Mailing Address - Fax:870-886-3252
Practice Address - Street 1:1210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALNUT RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72476-1005
Practice Address - Country:US
Practice Address - Phone:870-886-3543
Practice Address - Fax:870-886-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128549729Medicaid
AR128549729Medicaid