Provider Demographics
NPI:1861572620
Name:BRYANT MEDICAL CLINIC
Entity type:Organization
Organization Name:BRYANT MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:SKELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-653-0353
Mailing Address - Street 1:319 BRYANT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3815
Mailing Address - Country:US
Mailing Address - Phone:501-653-0353
Mailing Address - Fax:501-653-0347
Practice Address - Street 1:319 BRYANT AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3815
Practice Address - Country:US
Practice Address - Phone:501-653-0353
Practice Address - Fax:501-653-0347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty