Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 502 Richie Rd, Cabot, Arkansas |
Authorized Official Name and Position | Steven Collier (CEO) |
Authorized Official Contact | 8703473304 |
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) 347-2534 | 502 Richie Rd Cabot AR 72023-3309 Ph: (501) 941-0940 |
NPI Number | 1902263783 |
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Provider Enumeration Date | 01/25/2016 |
Last Update Date | 01/20/2021 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20160215000710 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902263783 | NPI | - | NPPES |
212697749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Arkansas) | Primary |
Jerry L Harvey, Do, Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15361 Highway 5, Suite E, Cabot, AR 72023 Phone: 501-605-9355 | |