Petty Medical Clinic, Llc | |
114 Harrison Ave Suite C Lowell AR 72745-9047 | |
(479) 254-1005 | |
(479) 668-4003 |
Full Name | Petty Medical Clinic, Llc |
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Speciality | Clinic/center - Primary Care |
Location | 114 Harrison Ave, Lowell, Arkansas |
Authorized Official Name and Position | Corwin Petty (PHYSICIAN / OWNER) |
Authorized Official Contact | 4795024435 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Petty Medical Clinic, Llc 114 Harrison Ave Suite C Lowell AR 72745-9047 Ph: (479) 254-1005 | Petty Medical Clinic, Llc 114 Harrison Ave Suite C Lowell AR 72745-9047 Ph: (479) 254-1005 |
NPI Number | 1255746772 |
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Provider Enumeration Date | 06/23/2014 |
Last Update Date | 06/23/2014 |
Identifier | Type | State | Issuer |
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1255746772 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | E2717 (Arkansas) | Primary |