| |
213 W Monroe Ave Suite P Lowell AR 72745-9451 | |
(479) 770-0221 | |
(866) 497-4412 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 213 W Monroe Ave, Lowell, Arkansas |
Authorized Official Name and Position | Kathy Lynn Mayhew (OWNER/PRESIDENT) |
Authorized Official Contact | 4797700221 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1189 Lowell AR 72745-1189 Ph: (479) 770-0221 | 213 W Monroe Ave Suite P Lowell AR 72745-9451 Ph: (479) 770-0221 |
NPI Number | 1225083181 |
---|---|
Provider Enumeration Date | 05/22/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225083181 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | E-0305 (Arkansas) | Primary |
Petty Medical Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 114 Harrison Ave, Suite C, Lowell, AR 72745 Phone: 479-254-1005 Fax: 479-668-4003 | |