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1605 Second Street Earle AR 72331-1634 | |
(870) 792-8825 | |
(870) 792-8834 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1605 Second Street, Earle, Arkansas |
Authorized Official Name and Position | Sudesh Banaji (OWNER) |
Authorized Official Contact | 8707928825 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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332 E Cook St Forrest City AR 72335-2830 Ph: (870) 630-2233 | 1605 Second Street Earle AR 72331-1634 Ph: (870) 792-8825 |
NPI Number | 1639319411 |
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Provider Enumeration Date | 03/06/2009 |
Last Update Date | 05/16/2014 |
Medicare PECOS PAC ID | 4486719879 |
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Medicare Enrollment ID | O20090508000271 |
Identifier | Type | State | Issuer |
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1639319411 | NPI | - | NPPES |