NPIMap

Organization Active NPI

Petty Medical Clinic, LLC

  • Primary Care Clinic/Center
  • Lowell, AR
National Provider Identifier
1255746772
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
E2717 Issued in AR
Legal business name
PETTY MEDICAL CLINIC, LLC
Practice address
114 Harrison Ave
Suite C
Lowell, AR 72745-9047
Phone
(479) 254-1005
Fax
(479) 668-4003
NPI assigned
Jun 23, 2014
Last updated
Jun 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Authorized official

Name
Dr. Corwin Petty, MDNPI 1295735959
Title
Physician / Owner
Phone
(479) 502-4435

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X E2717 AR Primary

Addresses

Primary practice location

114 Harrison Ave
Suite C
Lowell, AR 72745-9047

Mailing address

114 Harrison Ave
Suite C
Lowell, AR 72745-9047
Phone (479) 254-1005

National Provider Directory

National Provider Directory

Locations

114 Harrison Ave
Ste C
Lowell, AR 72745
Phone (479) 254-1005

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

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": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403481600000",
    "number": "1255746772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 HARRISON AVE",
            "address_2": "SUITE C",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727459047",
            "telephone_number": "479-254-1005",
            "fax_number": "479-668-4003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 HARRISON AVE",
            "address_2": "SUITE C",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727459047",
            "telephone_number": "479-254-1005",
            "fax_number": "479-668-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2014-06-23",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "CORWIN",
        "authorized_official_title_or_position": "PHYSICIAN / OWNER",
        "authorized_official_telephone_number": "479-502-4435",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AR",
            "license": "E2717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lowell, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.