1457226706 NPI number — HUNTSVILLE MEDICAL CLINIC, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457226706 NPI number — HUNTSVILLE MEDICAL CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTSVILLE MEDICAL CLINIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457226706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 PHILLIPS PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72740-6266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-738-1700
Provider Business Mailing Address Fax Number:
479-738-5510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 PHILLIPS PL
Provider Second Line Business Practice Location Address:
PO BOX 860
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-738-1700
Provider Business Practice Location Address Fax Number:
479-738-5510
Provider Enumeration Date:
10/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
DICKEY
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
479-738-1700

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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