The Shot Clinic, LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

C-5114 Issued in AR

Legal business name

THE SHOT CLINIC, LLC

Practice address

10720 N Rodney Parham Rd
Suite B5
Little Rock, AR 72212-4177

Phone

(501) 225-7468

Fax

(501) 224-1834

NPI assigned

Oct 9, 2013

Last updated

Oct 9, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Fred E Wilson, MD

Title

Medical Director

Phone

(501) 225-7468

Specialties & licenses 1

Addresses

Tax ID family

Robert Young MD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Robert Young MD

  • Health Service Clinic/Center
  • Little Rock, AR
  • NPI 1952794828
  NPD tax ID

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

{
    "created_epoch": "1381276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381276800000",
    "number": "1275960155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10720 N RODNEY PARHAM RD",
            "address_2": "SUITE B5",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722124177",
            "telephone_number": "501-225-7468",
            "fax_number": "501-224-1834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10720 N RODNEY PARHAM RD",
            "address_2": "SUITE B5",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722124177",
            "telephone_number": "501-225-7468",
            "fax_number": "501-224-1834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SHOT CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-09",
        "last_updated": "2013-10-09",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "501-225-7468",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AR",
            "license": "C-5114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Monroe Agency LLC
• The P.a.T. Center
• The Pharm, LLC (Chappell Psychological Services)
• The Range of Motion Store,Inc
• The Sage Center for Trauma and Wellness, PLLC
• The Sovereign Collective LLC
• The Surgery Center, LLC (The Surgical Pavilion, LLC)
• The Telos Clinic L.L.C.
• The Therapy Company
• The Triade Corporation

• Rural Health Clinic/Center in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Rural Health Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; 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.