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300 S School St Dermott AR 71638-2228 | |
(870) 538-5296 | |
(870) 538-3701 |
Full Name | |
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Speciality | Clinic/Center |
Location | 300 S School 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 | 300 S School St Dermott AR 71638-2228 Ph: (870) 538-5296 |
NPI Number | 1386758043 |
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Provider Enumeration Date | 08/19/2006 |
Last Update Date | 09/18/2024 |
Certification Date | 09/18/2024 |
Medicare PECOS PAC ID | 5193785590 |
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Medicare Enrollment ID | O20080324000149 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386758043 | NPI | - | NPPES |
122645749 | Medicaid | AR |