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105 N Jackson St Cabot AR 72023-3058 | |
(870) 347-2534 | |
(501) 941-3525 |
Full Name | |
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Speciality | Clinic/Center |
Location | 105 N Jackson St, Cabot, 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 | 105 N Jackson St Cabot AR 72023-3058 Ph: (870) 347-2534 |
NPI Number | 1255635496 |
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Provider Enumeration Date | 01/03/2011 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20110208001064 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255635496 | NPI | - | NPPES |
771125649 | Medicaid | AR | |
186145749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | 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 | |