| Arkansas Primary Care Clinics Pa | |
|
6209 W 12th St Little Rock AR 72204-1505 | |
| (501) 663-5221 | |
| (501) 663-6759 |
| Full Name | Arkansas Primary Care Clinics Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 6209 W 12th St, Little Rock, Arkansas |
| Authorized Official Name and Position | Derek Lewis (PRESIDENT) |
| Authorized Official Contact | 5016635221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arkansas Primary Care Clinics Pa 6209 W 12th St Little Rock AR 72204-1505 Ph: (501) 663-5221 | Arkansas Primary Care Clinics Pa 6209 W 12th St Little Rock AR 72204-1505 Ph: (501) 663-5221 |
| NPI Number | 1750345427 |
|---|---|
| Provider Enumeration Date | 04/12/2006 |
| Last Update Date | 02/25/2011 |
| Medicare PECOS PAC ID | 4981599974 |
|---|---|
| Medicare Enrollment ID | O20040218000747 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750345427 | NPI | - | NPPES |
| 116778002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Derek Lewis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407810641 PECOS PAC ID: 8022903020 Enrollment ID: I20071120000713 |
| Provider Name | Rose Marie Shaw Bullock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790749943 PECOS PAC ID: 5597933473 Enrollment ID: I20110720000246 |
| Provider Name | Vincent T Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235770942 PECOS PAC ID: 1658786751 Enrollment ID: I20210224000012 |
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