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1159 Main St Vilonia AR 72173-9525 | |
(501) 796-8484 | |
(501) 796-2453 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1159 Main St, Vilonia, Arkansas |
Authorized Official Name and Position | William Pack (CFO) |
Authorized Official Contact | 5014502112 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 9662 Conway AR 72033-9662 Ph: (501) 852-1363 | 1159 Main St Vilonia AR 72173-9525 Ph: (501) 796-8484 |
NPI Number | 1063798858 |
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Provider Enumeration Date | 10/25/2011 |
Last Update Date | 11/09/2023 |
Medicare PECOS PAC ID | 3173428414 |
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Medicare Enrollment ID | O20170109002869 |
Identifier | Type | State | Issuer |
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1063798858 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | E5175 (Arkansas) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |