Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 705 Hwy 63, Hazen, 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 |
---|---|
Po Box 497 Augusta AR 72006-0497 Ph: (870) 255-3696 | 705 Hwy 63 Hazen AR 72064-8054 Ph: (870) 255-3696 |
NPI Number | 1396706099 |
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Provider Enumeration Date | 03/31/2006 |
Last Update Date | 01/20/2021 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20100607000546 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396706099 | NPI | - | NPPES |
122568749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |