| Benton Town Branch | |
|
1502 Mary Kay Blvd Benton AR 72015 | |
| (501) 315-3344 | |
| Not Available |
| Full Name | Benton Town Branch |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1502 Mary Kay Blvd, Benton, Arkansas |
| Authorized Official Name and Position | Rolando Garcia (CFO) |
| Authorized Official Contact | 5013153344 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Benton Town Branch Po Box 1589 Benton AR 72018-1589 Ph: (501) 315-3344 | Benton Town Branch 1502 Mary Kay Blvd Benton AR 72015 Ph: (501) 315-3344 |
| NPI Number | 1912157967 |
|---|---|
| Provider Enumeration Date | 09/26/2008 |
| Last Update Date | 11/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912157967 | NPI | - | NPPES |
| 116374726 | Medicaid | AR | |
| 171626526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Arkansas) | Primary |
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