Provider Demographics
NPI:1053677377
Name:YOUNG MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:YOUNG MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:870-642-4730
Mailing Address - Street 1:1302 W COLLIN RAYE DR STE A
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2588
Mailing Address - Country:US
Mailing Address - Phone:870-642-4730
Mailing Address - Fax:870-381-7273
Practice Address - Street 1:1302 W COLLIN RAYE DR STE A
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2588
Practice Address - Country:US
Practice Address - Phone:870-642-4730
Practice Address - Fax:870-381-7273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty