Provider Demographics
NPI:1770519100
Name:MCKIEVER CLINIC
Entity type:Organization
Organization Name:MCKIEVER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCKIEVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-367-6822
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71657-0490
Mailing Address - Country:US
Mailing Address - Phone:870-367-6822
Mailing Address - Fax:870-367-0311
Practice Address - Street 1:766 H L ROSS DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5706
Practice Address - Country:US
Practice Address - Phone:870-367-6822
Practice Address - Fax:870-367-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5941261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57637Medicare ID - Type Unspecified
ARD84274Medicare UPIN