Provider Demographics
NPI:1972141794
Name:ALLCARE FAMILY MEDICAL CLINIC INC
Entity type:Organization
Organization Name:ALLCARE FAMILY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:SHONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-712-6144
Mailing Address - Street 1:PO BOX 1872
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-4372
Mailing Address - Country:US
Mailing Address - Phone:662-712-6144
Mailing Address - Fax:
Practice Address - Street 1:109 EUREKA ST STE B
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2534
Practice Address - Country:US
Practice Address - Phone:662-299-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty