| |
212 W Monroe Ave Ste B Lowell AR 72745-9451 | |
(479) 365-7100 | |
(877) 612-6228 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 212 W Monroe Ave Ste B, Lowell, 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 |
---|---|
Po Box 497 Augusta AR 72006-0497 Ph: (870) 347-2534 | 212 W Monroe Ave Ste B Lowell AR 72745-9451 Ph: (479) 365-7100 |
NPI Number | 1568238517 |
---|---|
Provider Enumeration Date | 11/30/2023 |
Last Update Date | 12/06/2023 |
Medicare PECOS PAC ID | 2567370620 |
---|---|
Medicare Enrollment ID | O20240305000400 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568238517 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Petty Medical Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 114 Harrison Ave, Suite C, Lowell, AR 72745 Phone: 479-254-1005 Fax: 479-668-4003 | |