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720 Lexington Ave Fort Smith AR 72901-4738 | |
| (479) 910-3169 | |
| (479) 600-5051 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 720 Lexington Ave, Fort Smith, Arkansas |
| Authorized Official Name and Position | Lucinda J Shepherd (OWNER) |
| Authorized Official Contact | 4794096049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 6632 Springdale AR 72766-6632 Ph: (479) 409-6049 | 720 Lexington Ave Fort Smith AR 72901-4738 Ph: (479) 910-3169 |
| NPI Number | 1508540956 |
|---|---|
| Provider Enumeration Date | 06/14/2023 |
| Last Update Date | 08/06/2024 |
| Certification Date | 08/06/2024 |
| Medicare PECOS PAC ID | 2062875859 |
|---|---|
| Medicare Enrollment ID | O20230827000136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508540956 | NPI | - | NPPES |
| 322060002 | Medicaid | AR |
| Provider Name | Harry Lazarte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548486053 PECOS PAC ID: 1456424274 Enrollment ID: I20210329001876 |
| Provider Name | Melinda Justice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972232593 PECOS PAC ID: 3678953213 Enrollment ID: I20220629001456 |
| Provider Name | Maylynn York |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740355437 PECOS PAC ID: 3678923471 Enrollment ID: I20231220000231 |
| Provider Name | Kirsten Orange |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881167666 PECOS PAC ID: 6901240761 Enrollment ID: I20240220002576 |
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