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557 Kirkwood Rd Star City AR 71667-8843 | |
(870) 628-5110 | |
(855) 854-6281 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 557 Kirkwood Rd, Star City, Arkansas |
Authorized Official Name and Position | Gary Allan Nichols (CEO) |
Authorized Official Contact | 8709423000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 509 Dermott AR 71638-0509 Ph: (870) 942-3000 | 557 Kirkwood Rd Star City AR 71667-8843 Ph: (870) 628-5110 |
NPI Number | 1649679051 |
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Provider Enumeration Date | 08/21/2014 |
Last Update Date | 09/16/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649679051 | NPI | - | NPPES |
205925631 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |