| |
1159 Main St Vilonia AR 72173-9525 | |
(501) 796-8484 | |
(501) 796-2453 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1159 Main St, Vilonia, Arkansas |
Authorized Official Name and Position | Charles W. Himmler (OWNER) |
Authorized Official Contact | 5017968484 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
1159 Main St P.o. Box 359 Vilonia AR 72173-9525 Ph: (501) 796-8484 | 1159 Main St Vilonia AR 72173-9525 Ph: (501) 796-8484 |
NPI Number | 1225140585 |
---|---|
Provider Enumeration Date | 08/31/2006 |
Last Update Date | 06/25/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225140585 | NPI | - | NPPES |
080017971 | Other | RR MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |