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1400 Braden St Ste 1 Jacksonville AR 72076-3721 | |
(501) 241-1676 | |
(501) 241-1427 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1400 Braden St Ste 1, Jacksonville, 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 | 1400 Braden St Ste 1 Jacksonville AR 72076-3721 Ph: (501) 241-1676 |
NPI Number | 1760963516 |
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Provider Enumeration Date | 08/28/2018 |
Last Update Date | 01/20/2021 |
Medicare PECOS PAC ID | 2567370620 |
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Medicare Enrollment ID | O20181017000901 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760963516 | NPI | - | NPPES |
232628749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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