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3519 Highway 63 Black Rock AR 72415 | |
(870) 878-4005 | |
(870) 994-7488 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3519 Highway 63, Black Rock, Arkansas |
Authorized Official Name and Position | Bradley R Bibb (PRESIDENT) |
Authorized Official Contact | 8709947301 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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49 Highway 62 412 Ash Flat AR 72513-9594 Ph: () - | 3519 Highway 63 Black Rock AR 72415 Ph: (870) 878-4005 |
NPI Number | 1437569837 |
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Provider Enumeration Date | 05/07/2014 |
Last Update Date | 02/03/2020 |
Medicare PECOS PAC ID | 4789715285 |
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Medicare Enrollment ID | O20140716000863 |
Identifier | Type | State | Issuer |
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1437569837 | NPI | - | NPPES |
204416002 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |