Health for Life Clinic PLLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

C4604 Issued in AR

Legal business name

HEALTH FOR LIFE CLINIC PLLC

Practice address

1100 N University Ave
Ste 260
Little Rock, AR 72207-6343

Phone

(501) 603-0003

Fax

(501) 603-0030

NPI assigned

Oct 31, 2012

Organization subpart

No

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

Authorized official

Name

Tia Proctor

Title

Billing Administrator

Phone

(501) 603-0003

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351641600000",
    "number": "1760736565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N UNIVERSITY AVE",
            "address_2": "STE 260",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722076343",
            "telephone_number": "501-603-0003",
            "fax_number": "501-603-0030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N UNIVERSITY AVE",
            "address_2": "STE 260",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722076343",
            "telephone_number": "501-603-0003",
            "fax_number": "501-603-0030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH FOR LIFE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-31",
        "last_updated": "2012-10-31",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "TIA",
        "authorized_official_title_or_position": "BILLING ADMINISTRATOR",
        "authorized_official_telephone_number": "501-603-0003"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "AR",
            "license": "C4604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104422001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Little Rock, AR
• Providers in Little Rock, 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 Oct 31, 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.