NPIMap

Organization Active NPI

Great River Medical Center LLC

Doing business as Great River Family Clinic

  • Family Medicine Physician
  • Blytheville, AR
National Provider Identifier
1083532618
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREAT RIVER MEDICAL CENTER LLC
Doing business as
Great River Family Clinic
Great River Pain Clinic
Great River Physician Services3 more in Other names
Practice address
1520 N Division St
Blytheville, AR 72315-1448
Phone
(870) 838-7300
NPI assigned
Jul 9, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Authorized official

Name
Lacey Carter
Title
Ceo
Phone
(870) 838-7460

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X

Addresses

Primary practice location

1520 N Division St
Blytheville, AR 72315-1448

Mailing address

PO Box 108
Blytheville, AR 72316-0108
Phone (870) 838-7300

Other names 6

  • Great River Family Clinic Doing business as
  • Great River Pain Clinic Doing business as
  • Great River Physician Services Doing business as
  • Great River Specialty Clinic Doing business as
  • Great River Women's Clinic Doing business as
  • Mississippi County Primary Care Physicians Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Great River Medical Center LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1783555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1083532618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 108",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723160108",
            "telephone_number": "870-838-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N DIVISION ST",
            "city": "BLYTHEVILLE",
            "state": "AR",
            "postal_code": "723151448",
            "telephone_number": "870-838-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVER MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-09",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "LACEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-838-7460"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great River Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great River Pain Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great River Physician Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great River Specialty Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great River Women's Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mississippi County Primary Care Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blytheville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; 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.