| N/a | |
|
6814 Princeton Pike Pine Bluff AR 71602-9411 | |
| (501) 353-3765 | |
| Not Available |
| Full Name | N/a |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 6814 Princeton Pike, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Shawn Michael Richard (PHYSICIAN) |
| Authorized Official Contact | 5018033418 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a Po Box 13585 Maumelle AR 72113-0585 Ph: () - | N/a 6814 Princeton Pike Pine Bluff AR 71602-9411 Ph: (501) 353-3765 |
| NPI Number | 1639561103 |
|---|---|
| Provider Enumeration Date | 02/20/2015 |
| Last Update Date | 02/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639561103 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | E-5344 (Arkansas) | Primary |
| 273R00000X | Psychiatric Unit | 022748 (Louisiana) | Secondary |
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