Provider Demographics
NPI:1831709518
Name:METHENY FAMILY CARE CLINIC CORP
Entity type:Organization
Organization Name:METHENY FAMILY CARE CLINIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:METHENY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:479-879-3400
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:ELM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72728-0083
Mailing Address - Country:US
Mailing Address - Phone:470-879-3400
Mailing Address - Fax:
Practice Address - Street 1:700 N 40TH ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0633
Practice Address - Country:US
Practice Address - Phone:479-318-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty