FAIR PARK MEDICAL CLINIC (NPI# 1740481191) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1740481191 |
Entity Type | Organization |
Organization Name | FAIR PARK MEDICAL CLINIC |
Other Organization Name | FAIR PARK MEDICAL CLINIC |
Practice Address |
5320 W 12th St Little Rock AR 72204-1859 |
Mailing Address |
5320 W. 12th Street Little Rock AR 72206 |
Practice Telephone | 5016636262 |
Practice Fax Number | 5016633189 |
Mailing Telephone | 5016636262 |
Mailing Fax Number | 5016633189 |
Enumeration Date | 2007-05-31 |
Last Update Date | 2020-08-22 |
Authorized Official Name | DR. CARL LYNN JOHNSON (OWNER) |
Authorized Official Telephone | 5016636262 |
Authorized Official Credential | M.D. |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207R00000X | Internal Medicine | MC2208 | AR | Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Fair Park Medical Clinic | Doing Business As Name - Organization |
Street Address |
5320 W 12TH ST |
City | LITTLE ROCK |
State | AR |
Zip Code | 72204-1859 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437264033 | Carl L Johnson | Internal Medicine | 5320 W 12th St, Little Rock, AR 72204 | 2006-08-21 |
1679845580 | Bio-medical Applications of Arkansas, Inc. | Clinic/Center | 5320 W 12th St, Little Rock, AR 72204-1859 | 2012-02-08 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1669952966 | Shane Wilson | Non-emergency Medical Transport (VAN) | 1522 S Tyler St, Little Rock, AR 72204 | 2018-08-16 |
1659858348 | Poplar Grove Operations LLC | Skilled Nursing Facility | 7801 Kanis Road, Little Rock, AR 72204 | 2018-07-25 |
1275056004 | University of Arkansas for Medical Sciences | Orthopaedic Surgery | 108015 Colonel Glenn Rd, Little Rock, AR 72204 | 2017-07-24 |
1265954820 | Marilyn Marie Lynch | Registered Nurse | 7723 Colonel Glenn Road, Little Rock, AR 72204 | 2017-07-14 |
1962852954 | Arkansas Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 1122 S. University Ave, Little Rock, AR 72204 | 2016-06-21 |
1841607751 | Charity Gillespie | Registered Nurse | 5210 Timberland Dr, Little Rock, AR 72204 | 2014-07-14 |
1043625221 | Interventional Surgery Institute of Little Rock, LLC | Clinic/Center | 9 Freeway Drive, Suite A, Little Rock, AR 72204 | 2014-06-25 |
1548696065 | Jamie Washington | Prosthetic/Orthotic Supplier | 4701 Westwood Ave, Little Rock, AR 72204 | 2013-09-16 |
1124468913 | Stephanie Rachelle Jez | Genetic Counselor, MS | 5800 West 10th Street, Freeway Medical Building, Suite 7-500, Little Rock, AR 72204 | 2013-06-26 |
1336492321 | Alton Charles Phillips Sr. | Counselor | 4400shuffield Drive, Little Rock, AR 72204 | 2012-10-16 |
Find all providers in zip 72204 |
Taxonomy Code | 207R00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1043788045 | Arkansas Wellness Associates LLC | Internal Medicine | 10700 N Rodney Parham Road, Suite C11, Little Rock, AR 72212 | 2018-11-07 |
1740797422 | Healthville Pllc | Internal Medicine | 11219 Financial Centre Pkwy Ste 316, Little Rock, AR 72211-3895 | 2018-01-04 |
1396284105 | Hospital Medicine | Internal Medicine | 2 Saint Vincent Cir # 6, Little Rock, AR 72205-5423 | 2017-02-14 |
1114313962 | Dinesh Atwal | Internal Medicine | 4301 West Markham, Slot 634, Little Rock, AR 72205-7199 | 2015-04-08 |
1780095323 | Mahreen Arshad | Internal Medicine | 300 S Shackleford Rd, Little Rock, AR 72211 | 2014-05-16 |
1578986212 | Pankaj Mathur | Internal Medicine | 4301 W Markham St # 810, Little Rock, AR 72205-7101 | 2014-01-31 |
1275977894 | Srilakshmi Ravula | Internal Medicine | 4301 W Markham St # 610, Little Rock, AR 72205-7101 | 2013-04-25 |
1144664491 | Thomas Edward Kasprowicz | Internal Medicine | 9500 Kanis Rd Ste 410, Little Rock, AR 72205-6377 | 2013-04-17 |
1194087965 | Jose Diego Caceres | Internal Medicine | 4301 W Markham Street, Pulmonary and Ccm, Slot 555, Little Rock, AR 72205 | 2012-06-08 |
1942566419 | Christopher Michael Merrick | Internal Medicine | 4224 B St, Little Rock, AR 72205-4052 | 2012-04-09 |
Find all providers in LITTLE ROCK |
City | LITTLE ROCK |
Zip Code | 72204 |
Please comment or provide details below to improve the information on FAIR PARK MEDICAL CLINIC.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.