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AUTUMN ROAD FAMILY PRACTICE P.A NPI 1629027818


NPI Information

NPI: 1629027818
Provider Name: AUTUMN ROAD FAMILY PRACTICE, P.A,
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization

CLIA Number: 04D0467303

Address:
904 AUTUMN RD
SUITE 200
LITTLE ROCK, AR
ZIP 72211
Phone: (501) 227-6363
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AUTUMN ROAD FAMILY PRACTICE, P.A, is a clinic center in Little Rock, AR. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). AUTUMN ROAD FAMILY PRACTICE, P.A, NPI is 1629027818. The provider is registered as an organization entity type.

The provider's business location address is:

904 AUTUMN RD
SUITE 200
LITTLE ROCK, AR
ZIP 72211-737
Phone: (501) 227-6363
Fax: (501) 227-8629

The provider's authorized official is Dawn Drennan .
The authorized official title is Administrator and has the following contact phone number (501) 626-7515.

The CLIA number assigned to this NPI record is 04D0467303 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 5/8/2006 and was last updated on 5/31/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261Q00000XClinic/CenterMC0079ARKANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1111026102MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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