NPIMap

Organization Active NPI

Wynne Medical Clinic PA

  • Family Medicine Physician
  • Wynne, AR
National Provider Identifier
1548376148
Registry record updated Sep 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WYNNE MEDICAL CLINIC PA
Practice address
710 Falls Blvd S
Wynne, AR 72396-3514
Phone
(870) 238-2321
Fax
(870) 238-0114
NPI assigned
Aug 23, 2006
Last updated
Sep 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2013

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

Authorized official

Name
Ms. Shelia Burrow
Title
Office Manager
Phone
(870) 238-2321

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

710 Falls Blvd S
Wynne, AR 72396-3514

Mailing address

PO Box 158
Wynne, AR 72396-0158
Phone (870) 238-2321

Other identifiers 1

IdentifierTypeStateIssuer
102040002MedicaidAR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379980800000",
    "number": "1548376148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723960158",
            "telephone_number": "870-238-2321",
            "fax_number": "870-238-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 FALLS BLVD S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963514",
            "telephone_number": "870-238-2321",
            "fax_number": "870-238-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYNNE MEDICAL CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2013-09-24",
        "status": "A",
        "authorized_official_last_name": "BURROW",
        "authorized_official_first_name": "SHELIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-238-2321",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102040002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wynne, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.