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2624 Hwy 42 Cherry Valley AR 72324-8674 | |
(870) 442-2040 | |
(870) 442-2041 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2624 Hwy 42, Cherry Valley, Arkansas |
Authorized Official Name and Position | Steven Collier (CEO) |
Authorized Official Contact | 8703472534 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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623 N 9th St Po Box 497 Augusta AR 72006-2129 Ph: (870) 347-2534 | 2624 Hwy 42 Cherry Valley AR 72324-8674 Ph: (870) 442-2040 |
NPI Number | 1437436573 |
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Provider Enumeration Date | 11/03/2011 |
Last Update Date | 01/20/2021 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20120104000347 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437436573 | NPI | - | NPPES |
189791749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |