| Arkansas Mobile Wound Management Pllc | |
|
7509 S Shoreline Blvd Benton AR 72019-8473 | |
| (501) 602-8979 | |
| Not Available |
| Full Name | Arkansas Mobile Wound Management Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 7509 S Shoreline Blvd, Benton, Arkansas |
| Authorized Official Name and Position | Holly Balogh (OWNER) |
| Authorized Official Contact | 5016028979 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arkansas Mobile Wound Management Pllc 7509 S Shoreline Blvd Benton AR 72019-8473 Ph: () - | Arkansas Mobile Wound Management Pllc 7509 S Shoreline Blvd Benton AR 72019-8473 Ph: (501) 602-8979 |
| NPI Number | 1871348441 |
|---|---|
| Provider Enumeration Date | 04/18/2024 |
| Last Update Date | 05/03/2024 |
| Medicare PECOS PAC ID | 8325488612 |
|---|---|
| Medicare Enrollment ID | O20240503000938 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871348441 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
| Provider Name | Julius G Balogh |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1588923544 PECOS PAC ID: 3476969197 Enrollment ID: I20210304000441 |
| Provider Name | Holly Marie Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659982411 PECOS PAC ID: 0648662494 Enrollment ID: I20220127003076 |
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