| Willis Clinic Pllc | |
|
616 W Lee Ave Osceola AR 72370-3002 | |
| (870) 563-2545 | |
| (870) 563-2482 |
| Full Name | Willis Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 616 W Lee Ave, Osceola, Arkansas |
| Authorized Official Name and Position | Timothy W Willis (COO/PRACTICE MANAGER) |
| Authorized Official Contact | 8705632545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willis Clinic Pllc 616 W Lee Ave Osceola AR 72370-3002 Ph: (870) 563-2545 | Willis Clinic Pllc 616 W Lee Ave Osceola AR 72370-3002 Ph: (870) 563-2545 |
| NPI Number | 1063619567 |
|---|---|
| Provider Enumeration Date | 06/28/2007 |
| Last Update Date | 01/20/2021 |
| Medicare PECOS PAC ID | 1456436930 |
|---|---|
| Medicare Enrollment ID | O20120918000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063619567 | NPI | - | NPPES |
| 165422001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | E5031 (Arkansas) | Primary |
| Provider Name | Sherita D Willis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740326610 PECOS PAC ID: 5799877643 Enrollment ID: I20070822001504 |
| Provider Name | Carolyn A Coleman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407388267 PECOS PAC ID: 4183980824 Enrollment ID: I20190328001890 |
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