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525 E Speedway St Dermott AR 71638-2322 | |
(870) 538-3355 | |
(855) 811-4203 |
Full Name | |
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Speciality | Clinic/Center |
Location | 525 E Speedway St, Dermott, Arkansas |
Authorized Official Name and Position | Gary Allan Nichols (CEO) |
Authorized Official Contact | 8709423000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 509 Dermott AR 71638-0509 Ph: (870) 942-3000 | 525 E Speedway St Dermott AR 71638-2322 Ph: (870) 538-3355 |
NPI Number | 1477004471 |
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Provider Enumeration Date | 10/14/2016 |
Last Update Date | 09/18/2024 |
Certification Date | 09/18/2024 |
Medicare PECOS PAC ID | 5193785590 |
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Medicare Enrollment ID | O20170201000335 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477004471 | NPI | - | NPPES |
217430749 | Medicaid | AR |