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1125 N College Ave Fayetteville AR 72703-1908 | |
(479) 521-8269 | |
(479) 443-3903 |
Full Name | |
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Speciality | Family Medicine |
Location | 1125 N College Ave, Fayetteville, Arkansas |
Authorized Official Name and Position | B J Roberts (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4795218269 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1125 N College Ave Fayetteville AR 72703-1908 Ph: (479) 521-8269 | 1125 N College Ave Fayetteville AR 72703-1908 Ph: (479) 521-8269 |
NPI Number | 1417110230 |
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Provider Enumeration Date | 07/02/2008 |
Last Update Date | 01/28/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417110230 | NPI | - | NPPES |
56997 | Other | AR | AR BCBS |
770033568 | Other | AR | AR BREAST CARE |
170583069 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
K E Management Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1420 E Augustine Ln Ste 7, Fayetteville, AR 72703 Phone: 479-200-9812 Fax: 866-243-7203 | |
Arcare Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1792 E Joyce Blvd, Fayetteville, AR 72703 Phone: 501-500-5001 Fax: 501-500-5001 | |