Direct Md, Llc | |
2223 Grant St Malvern AR 72104-4700 | |
(501) 337-9031 | |
Not Available |
Full Name | Direct Md, Llc |
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Speciality | Family Medicine |
Location | 2223 Grant St, Malvern, Arkansas |
Authorized Official Name and Position | Kim M Morgan (DIRECTOR CREDENTIALING) |
Authorized Official Contact | 5019788604 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Direct Md, Llc 1701 S Shackleford Rd Little Rock AR 72211-4335 Ph: (501) 219-7000 | Direct Md, Llc 2223 Grant St Malvern AR 72104-4700 Ph: (501) 337-9031 |
NPI Number | 1457077356 |
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Provider Enumeration Date | 10/13/2022 |
Last Update Date | 06/08/2023 |
Medicare PECOS PAC ID | 5395116941 |
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Medicare Enrollment ID | O20230119000562 |
Identifier | Type | State | Issuer |
---|---|---|---|
1457077356 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Dylan Thaxton |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1609040849 PECOS PAC ID: 6406921667 Enrollment ID: I20080822000210 |
Provider Name | Shea Don Oxford |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205293750 PECOS PAC ID: 6204134059 Enrollment ID: I20160412002381 |
Provider Name | Cynthia D Durham |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1902475635 PECOS PAC ID: 2668875550 Enrollment ID: I20210729003181 |
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