Provider Demographics
NPI:1174959795
Name:WILLIS CLINIC EXPRESS
Entity type:Organization
Organization Name:WILLIS CLINIC EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:870-622-9212
Mailing Address - Street 1:616 W LEE AVE
Mailing Address - Street 2:STE 2A
Mailing Address - City:OSCEOLA
Mailing Address - State:AR
Mailing Address - Zip Code:72370-3002
Mailing Address - Country:US
Mailing Address - Phone:870-622-9212
Mailing Address - Fax:870-576-4350
Practice Address - Street 1:616 W LEE AVE
Practice Address - Street 2:STE 2A
Practice Address - City:OSCEOLA
Practice Address - State:AR
Practice Address - Zip Code:72370-3002
Practice Address - Country:US
Practice Address - Phone:870-622-9212
Practice Address - Fax:870-576-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care