Urban Medical Clinic

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

R3890 Issued in AR

Legal business name

URBAN MEDICAL CLINIC

Practice address

1 West Cherokee Village Mall #12
Cherokee Village, AR 72529

Phone

(870) 257-4110

Fax

(870) 257-4112

NPI assigned

Jan 12, 2011

Organization subpart

No

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

Authorized official

Name

Ross Douglas

Title

Billing Manager

Phone

(870) 424-5079

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1294790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1295030815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726540310",
            "telephone_number": "870-424-5079",
            "fax_number": "870-424-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WEST CHEROKEE VILLAGE MALL #12",
            "city": "CHEROKEE VILLAGE",
            "state": "AR",
            "postal_code": "72529",
            "telephone_number": "870-257-4110",
            "fax_number": "870-257-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "URBAN MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-12",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "870-424-5079"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "R3890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Cherokee Village, AR
• Providers in Cherokee Village, AR by specialty
• General Practice Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; 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.