| |
304 Main St Pangburn AR 72121-8959 | |
(501) 728-3388 | |
(501) 728-3391 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 304 Main St, Pangburn, Arkansas |
Authorized Official Name and Position | Steven Collier (CEO) |
Authorized Official Contact | 8703473300 |
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 | 304 Main St Pangburn AR 72121-8959 Ph: (501) 728-3388 |
NPI Number | 1790334936 |
---|---|
Provider Enumeration Date | 09/10/2019 |
Last Update Date | 01/20/2021 |
Medicare PECOS PAC ID | 2567370620 |
---|---|
Medicare Enrollment ID | O20191104003147 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790334936 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |