Basic Information
| Provider Information | |||||||||
| NPI: | 1295368587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMC MEDICAL CLINIC I LLC | ||||||||
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| OtherOrganizationName: | AMC MEDICAL CLINIC LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4196 HIGHWAY 62 412 STE A | ||||||||
| Address2: | |||||||||
| City: | HARDY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725428002 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 218 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EUFAULA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744321633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186897705 | ||||||||
| FaxNumber: | 8558605341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2020 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | BIBB | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8708561202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.