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4077 Jefferson Ave Texarkana AR 71854-1509 | |
| (903) 614-5270 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4077 Jefferson Ave, Texarkana, Arkansas |
| Authorized Official Name and Position | Carla Roadcap (CEO) |
| Authorized Official Contact | 9039273782 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1326 Marshall TX 75671-1326 Ph: (903) 927-3782 | 4077 Jefferson Ave Texarkana AR 71854-1509 Ph: (903) 614-5270 |
| NPI Number | 1548745383 |
|---|---|
| Provider Enumeration Date | 09/27/2018 |
| Last Update Date | 08/28/2023 |
| Certification Date | 08/28/2023 |
| Medicare PECOS PAC ID | 8820038565 |
|---|---|
| Medicare Enrollment ID | O20190325000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548745383 | NPI | - | NPPES |
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