| Wacgc - 31st Street Clinic | |
|
2100 N 31st St Fort Smith AR 72904-6140 | |
| (479) 452-6650 | |
| (479) 785-9495 |
| Full Name | Wacgc - 31st Street Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2100 N 31st St, Fort Smith, Arkansas |
| Authorized Official Name and Position | Jim West (CEO) |
| Authorized Official Contact | 4794526650 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wacgc - 31st Street Clinic Po Box 11818 Fort Smith AR 72917-1818 Ph: (479) 452-6650 | Wacgc - 31st Street Clinic 2100 N 31st St Fort Smith AR 72904-6140 Ph: (479) 452-6650 |
| NPI Number | 1649501461 |
|---|---|
| Provider Enumeration Date | 01/18/2010 |
| Last Update Date | 10/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649501461 | NPI | - | NPPES |
| 181576526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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