Provider Demographics
NPI:1871622621
Name:DOC'S CLINIC AND INSTITUTE, PLC
Entity type:Organization
Organization Name:DOC'S CLINIC AND INSTITUTE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:OATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-251-1552
Mailing Address - Street 1:4220 N CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4593
Mailing Address - Country:US
Mailing Address - Phone:479-251-1552
Mailing Address - Fax:479-251-8956
Practice Address - Street 1:4220 N CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4593
Practice Address - Country:US
Practice Address - Phone:479-251-1552
Practice Address - Fax:479-251-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-5922261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD17023Medicare UPIN