| B A Scroggins, Inc. | |
|
1355 Dave Ward Dr Ste 101 Conway AR 72034-7082 | |
| (501) 269-5105 | |
| Not Available |
| Full Name | B A Scroggins, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1355 Dave Ward Dr Ste 101, Conway, Arkansas |
| Authorized Official Name and Position | Brent Ashley Scroggins (CEO) |
| Authorized Official Contact | 5012695105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| B A Scroggins, Inc. 350 Grandview Hts Conway AR 72032-8875 Ph: (501) 269-5105 | B A Scroggins, Inc. 1355 Dave Ward Dr Ste 101 Conway AR 72034-7082 Ph: (501) 269-5105 |
| NPI Number | 1013686641 |
|---|---|
| Provider Enumeration Date | 09/08/2021 |
| Last Update Date | 09/08/2021 |
| Medicare PECOS PAC ID | 3678961232 |
|---|---|
| Medicare Enrollment ID | O20211101001788 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013686641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Brent A Scroggins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205032745 PECOS PAC ID: 3274684881 Enrollment ID: I20090622000338 |
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