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205 Westport Dr Ste 1 Cabot AR 72023-3657 | |
(501) 843-6585 | |
(501) 843-2380 |
Full Name | |
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Speciality | Family Medicine |
Location | 205 Westport Dr Ste 1, Cabot, Arkansas |
Authorized Official Name and Position | Will L Rusher (CEO) |
Authorized Official Contact | 5018127500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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11001 Executive Center Dr Ste 200 Little Rock AR 72211-4393 Ph: (501) 812-7215 | 205 Westport Dr Ste 1 Cabot AR 72023-3657 Ph: (501) 843-6585 |
NPI Number | 1689633448 |
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Provider Enumeration Date | 03/21/2006 |
Last Update Date | 04/11/2019 |
Medicare PECOS PAC ID | 7911802079 |
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Medicare Enrollment ID | O20060329000704 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689633448 | NPI | - | NPPES |
128283002 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Edward J Vanderburg |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1376568204 PECOS PAC ID: 6406853753 Enrollment ID: I20061028000042 |
Provider Name | Joseph W Reardon |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1801858188 PECOS PAC ID: 9638223787 Enrollment ID: I20090824000739 |
Provider Name | James A Meserow |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1609818657 PECOS PAC ID: 4789666736 Enrollment ID: I20120220000786 |
Provider Name | Tiffany Celeste Wilson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1740765205 PECOS PAC ID: 0840629747 Enrollment ID: I20200327002123 |
Provider Name | Erica Gibson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1235522780 PECOS PAC ID: 2163852427 Enrollment ID: I20200429000459 |
Provider Name | Michael G Jerkins |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1417377334 PECOS PAC ID: 1658597356 Enrollment ID: I20210920003211 |
Provider Name | Joseph L Brown |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1245908292 PECOS PAC ID: 4183021652 Enrollment ID: I20210927000412 |
Jerry L Harvey, Do, Pa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15361 Highway 5, Suite E, Cabot, AR 72023 Phone: 501-605-9355 | |