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1205 E 35th St Texarkana AR 71854-2746 | |
| (870) 216-0080 | |
| (870) 216-0093 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1205 E 35th St, Texarkana, Arkansas |
| Authorized Official Name and Position | Carla Roadcap (CEO) |
| Authorized Official Contact | 9039273782 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1326 Marshall TX 75671-1326 Ph: (903) 927-3782 | 1205 E 35th St Texarkana AR 71854-2746 Ph: (870) 216-0080 |
| NPI Number | 1093186249 |
|---|---|
| Provider Enumeration Date | 10/14/2015 |
| Last Update Date | 12/12/2024 |
| Certification Date | 12/12/2024 |
| Medicare PECOS PAC ID | 8820038565 |
|---|---|
| Medicare Enrollment ID | O20160203000828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093186249 | NPI | - | NPPES |
| 213389749 | Medicaid | AR | |
| 356940201 | Medicaid | TX |
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