Provider Demographics
NPI:1134885833
Name:ITI CHITO ENTERPRISES INC
Entity type:Organization
Organization Name:ITI CHITO ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-765-0275
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:LOCKESBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71846-0315
Mailing Address - Country:US
Mailing Address - Phone:870-289-5192
Mailing Address - Fax:870-289-4223
Practice Address - Street 1:500 E COLLIN RAYE DR STE 2
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-8068
Practice Address - Country:US
Practice Address - Phone:870-289-5192
Practice Address - Fax:870-289-4223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOCKESBURG FAMILY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-17
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care