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1503 Main Street Des Arc AR 72040-3299 | |
(870) 256-4178 | |
(870) 256-4179 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1503 Main Street, Des Arc, Arkansas |
Authorized Official Name and Position | Steven F 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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Po Box 497 Augusta AR 72006-0497 Ph: (870) 256-4178 | 1503 Main Street Des Arc AR 72040-3299 Ph: (870) 256-4178 |
NPI Number | 1871554576 |
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Provider Enumeration Date | 03/31/2006 |
Last Update Date | 10/13/2021 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20090824000697 |
Identifier | Type | State | Issuer |
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1871554576 | NPI | - | NPPES |
122566749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |