| Otter Creek Family Clinic Pllc | |
|
11321 Interstate 30 Ste 101 Little Rock AR 72209-7059 | |
| (501) 455-1331 | |
| (501) 455-5597 |
| Full Name | Otter Creek Family Clinic Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11321 Interstate 30, Little Rock, Arkansas |
| Authorized Official Name and Position | Rita A Alexander (BILLING COORDINATOR) |
| Authorized Official Contact | 5014551331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Otter Creek Family Clinic Pllc 11321 Interstate 30 Ste 101 Little Rock AR 72209-7059 Ph: (501) 455-1331 | Otter Creek Family Clinic Pllc 11321 Interstate 30 Ste 101 Little Rock AR 72209-7059 Ph: (501) 455-1331 |
| NPI Number | 1336122340 |
|---|---|
| Provider Enumeration Date | 11/23/2005 |
| Last Update Date | 06/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336122340 | NPI | - | NPPES |
| 140671002 | Medicaid | AR | |
| CG8625 | Other | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | C5502 (Arkansas) | Primary |
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