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Contact Information

GREAT RIVER PEDIATRIC CLINIC
1521 N 10TH ST
STE F
BLYTHEVILLE, AR72315-1405
 Phone: 870-780-6832
 Fax: 870-780-6919
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for GREAT RIVER PEDIATRIC CLINIC

NPI Number 1467586131
LBN Legal business name GREAT RIVER PEDIATRIC CLINIC
Authorized official BENJAMIN ASAFO-BOAKYE - (PEDIATRICIAN)
Entity Organization
Organization subpart 1 No
Enumeration date 03/15/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
AR License # E-4133
AR Other 5F511 BLUE CROSS BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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