| Im A 10 Wellness Center, Llc | |
|
404 Lake Wood Dr Searcy AR 72143-9056 | |
| (501) 593-6997 | |
| (501) 325-2912 |
| Full Name | Im A 10 Wellness Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 404 Lake Wood Dr, Searcy, Arkansas |
| Authorized Official Name and Position | Shivonne Marie Mccarroll (OFFICE MANAGER) |
| Authorized Official Contact | 5015936997 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Im A 10 Wellness Center, Llc 404 Lake Wood Dr Searcy AR 72143-9056 Ph: (501) 593-6997 | Im A 10 Wellness Center, Llc 404 Lake Wood Dr Searcy AR 72143-9056 Ph: (501) 593-6997 |
| NPI Number | 1982141149 |
|---|---|
| Provider Enumeration Date | 01/26/2017 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 6709144934 |
|---|---|
| Medicare Enrollment ID | O20171218001435 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982141149 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 5940-C (Arkansas) | Primary |
| Provider Name | Sharon Devore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871539510 PECOS PAC ID: 5092890111 Enrollment ID: I20080312000687 |
| Provider Name | Pamela M Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922238559 PECOS PAC ID: 4082854567 Enrollment ID: I20130703000564 |
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