| |
1808 W Main St Russellville AR 72801-2724 | |
(479) 968-2841 | |
(479) 968-8189 |
Full Name | |
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Speciality | General Acute Care Hospital |
Location | 1808 W Main St, Russellville, Arkansas |
Authorized Official Name and Position | Charlotte Lawrence (SECRETARY) |
Authorized Official Contact | 6159207000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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103 Continental Pl Suite 200 Brentwood TN 37027-1041 Ph: (615) 844-9800 | 1808 W Main St Russellville AR 72801-2724 Ph: (479) 968-2841 |
NPI Number | 1033160049 |
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Provider Enumeration Date | 05/14/2006 |
Last Update Date | 07/31/2023 |
Certification Date | 07/31/2023 |
Medicare PECOS PAC ID | 1052217452 |
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Medicare Enrollment ID | O20031208000790 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033160049 | NPI | - | NPPES |
152329105 | Medicaid | AR |
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