NPIMap

Organization Active NPI

Leachville Primary Care Clinic, Inc

  • Specialist
  • Leachville, AR
National Provider Identifier
1376531160
Registry record updated Mar 8, 2012
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Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
C8443 Issued in AR
Legal business name
LEACHVILLE PRIMARY CARE CLINIC, INC
Practice address
111 S Main St
Leachville, AR 72438-0580
Phone
(870) 539-1115
Fax
(870) 539-1125
NPI assigned
Oct 6, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2012

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

Authorized official

Name
Mr. John S Johnson, M.D.
Title
Owner
Phone
(870) 539-1115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X C8443 AR Primary

Addresses

Primary practice location

111 S Main St
Leachville, AR 72438-0580

Mailing address

PO Box 580
111 S Main St
Leachville, AR 72438-0580
Phone (870) 539-1115

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331164800000",
    "number": "1376531160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 580",
            "address_2": "111 S MAIN ST",
            "city": "LEACHVILLE",
            "state": "AR",
            "postal_code": "724380580",
            "telephone_number": "870-539-1115",
            "fax_number": "870-539-1125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S MAIN ST",
            "city": "LEACHVILLE",
            "state": "AR",
            "postal_code": "724380580",
            "telephone_number": "870-539-1115",
            "fax_number": "870-539-1125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEACHVILLE PRIMARY CARE CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2012-03-08",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-539-1115",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AR",
            "license": "C8443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leachville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; 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.