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309 S Edline Altheimer AR 72004-8559 | |
(870) 766-8411 | |
(870) 766-8412 |
Full Name | |
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Speciality | Clinic/Center |
Location | 309 S Edline, Altheimer, Arkansas |
Authorized Official Name and Position | Larnell W Davis (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 8705432380 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1285 Pine Bluff AR 71613-1285 Ph: (870) 543-2380 | 309 S Edline Altheimer AR 72004-8559 Ph: (870) 766-8411 |
NPI Number | 1730385105 |
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Provider Enumeration Date | 06/22/2007 |
Last Update Date | 07/20/2007 |
Medicare PECOS PAC ID | 5193634509 |
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Medicare Enrollment ID | O20100610000152 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730385105 | NPI | - | NPPES |
122651749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |