| |
150 School Street Bearden AR 71720 | |
(870) 687-3637 | |
(870) 687-2502 |
Full Name | |
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Speciality | Family Medicine |
Location | 150 School Street, Bearden, Arkansas |
Authorized Official Name and Position | Susan Diane Johnston (BILLING SUPERVISOR) |
Authorized Official Contact | 8707983515 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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150 School Street Bearden AR 71720 Ph: (870) 687-3637 | 150 School Street Bearden AR 71720 Ph: (870) 687-3637 |
NPI Number | 1265476402 |
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Provider Enumeration Date | 06/16/2006 |
Last Update Date | 01/26/2012 |
Medicare PECOS PAC ID | 9133029234 |
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Medicare Enrollment ID | O20040217000907 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265476402 | NPI | - | NPPES |
122638749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |