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6701 Hwy 67 S Bldg 4 Benton AR 72015 | |
| (501) 315-3344 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6701 Hwy 67 S, Benton, Arkansas |
| Authorized Official Name and Position | Priscilla Trudell (HEALTH INFORMATION DIRECTOR) |
| Authorized Official Contact | 5013033115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1589 Benton AR 72018-1589 Ph: (501) 315-3344 | 6701 Hwy 67 S Bldg 4 Benton AR 72015 Ph: (501) 315-3344 |
| NPI Number | 1538102223 |
|---|---|
| Provider Enumeration Date | 06/13/2006 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538102223 | NPI | - | NPPES |
| 116374726 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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