NPIMap

Organization Active NPI

Maumelle Medical Clinic

  • Family Medicine Physician
  • Maumelle, AR
National Provider Identifier
1073629408
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MAUMELLE MEDICAL CLINIC
Practice address
600 Pine Forest Dr
Ste 200
Maumelle, AR 72113-6910
Phone
(501) 803-9900
NPI assigned
Aug 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerry Poole
Title
Manager
Phone
(501) 803-0999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

600 Pine Forest Dr
Ste 200
Maumelle, AR 72113-6910

Mailing address

600 Pine Forest Dr
Ste 200
Maumelle, AR 72113-6910
Phone (501) 803-9900

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073629408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PINE FOREST DR",
            "address_2": "STE 200",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721136910",
            "telephone_number": "501-803-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PINE FOREST DR",
            "address_2": "STE 200",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721136910",
            "telephone_number": "501-803-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUMELLE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "501-803-0999"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumelle, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.