Provider Demographics
NPI:1265440465
Name:CORPORATE MD, PLLC
Entity type:Organization
Organization Name:CORPORATE MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-208-6088
Mailing Address - Street 1:505 DAVE WARD DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-7825
Mailing Address - Country:US
Mailing Address - Phone:501-328-5885
Mailing Address - Fax:501-328-5886
Practice Address - Street 1:505 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-7825
Practice Address - Country:US
Practice Address - Phone:501-328-5885
Practice Address - Fax:501-328-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2506261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARMC-2506OtherMEDICAL BOARD CERTIFICATE