| |
721 Broadway St Smackover AR 71762-1822 | |
(870) 918-2032 | |
Not Available |
Full Name | |
---|---|
Speciality | Social Worker |
Location | 721 Broadway St, Smackover, Arkansas |
Authorized Official Name and Position | Connie Renee Landreneau (OWNER) |
Authorized Official Contact | 8709182032 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
721 Broadway St Smackover AR 71762-1822 Ph: () - | 721 Broadway St Smackover AR 71762-1822 Ph: (870) 918-2032 |
NPI Number | 1851816318 |
---|---|
Provider Enumeration Date | 08/07/2017 |
Last Update Date | 08/07/2017 |
Medicare PECOS PAC ID | 1951666783 |
---|---|
Medicare Enrollment ID | O20180529001900 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851816318 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Connie R Landreneau |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1316495237 PECOS PAC ID: 9638434467 Enrollment ID: I20180529002901 |