Provider Demographics
NPI:1548325160
Name:BACK TO HEALTH MEDICAL CLINIC
Entity type:Organization
Organization Name:BACK TO HEALTH MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DO
Authorized Official - Phone:479-484-7575
Mailing Address - Street 1:6800 S. DALLAS ST
Mailing Address - Street 2:STE A
Mailing Address - City:FT. SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5189
Mailing Address - Country:US
Mailing Address - Phone:479-484-7575
Mailing Address - Fax:
Practice Address - Street 1:6800 S. DALLAS ST
Practice Address - Street 2:STE A
Practice Address - City:FT. SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5189
Practice Address - Country:US
Practice Address - Phone:479-484-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-7372261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care