| |
3809 E 9th St Ste 15 Texarkana AR 71854-5818 | |
(870) 621-0080 | |
(870) 621-0081 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3809 E 9th St Ste 15, Texarkana, Arkansas |
Authorized Official Name and Position | Monya York (CONTROLLER) |
Authorized Official Contact | 8708561202 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4196 Highway 62 412 Ste A Hardy AR 72542-8002 Ph: (870) 856-1202 | 3809 E 9th St Ste 15 Texarkana AR 71854-5818 Ph: (870) 621-0080 |
NPI Number | 1871346064 |
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Provider Enumeration Date | 04/08/2024 |
Last Update Date | 11/07/2024 |
Medicare PECOS PAC ID | 4789715285 |
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Medicare Enrollment ID | O20240528002642 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871346064 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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