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145 N Curtis Ave Pea Ridge AR 72751-3407 | |
(479) 451-0579 | |
(479) 451-0297 |
Full Name | |
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Speciality | Clinic/Center |
Location | 145 N Curtis Ave, Pea Ridge, 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 |
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Po Box 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | 145 N Curtis Ave Pea Ridge AR 72751-3407 Ph: (479) 451-0579 |
NPI Number | 1073144028 |
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Provider Enumeration Date | 01/29/2020 |
Last Update Date | 10/09/2020 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20200319000211 |
Identifier | Type | State | Issuer |
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1073144028 | NPI | - | NPPES |
239378749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |