Provider Demographics
NPI:1912679549
Name:ITI CHITO ENTERPRISES INC
Entity Type:Organization
Organization Name:ITI CHITO ENTERPRISES INC
Other - Org Name:LOCKESBURG FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-765-0275
Mailing Address - Street 1:500 E. COLLIN RAYE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-8054
Mailing Address - Country:US
Mailing Address - Phone:870-642-7257
Mailing Address - Fax:870-642-5015
Practice Address - Street 1:500 E COLLIN RAYE DR STE 2
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-8068
Practice Address - Country:US
Practice Address - Phone:870-642-7257
Practice Address - Fax:870-642-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care