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1008 W Main St Marvell AR 72366-9486 | |
(870) 735-3842 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1008 W Main St, Marvell, Arkansas |
Authorized Official Name and Position | Debbie Brown (BILLING/CREDENTIALING MANAGER) |
Authorized Official Contact | 8707336388 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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900 N 7th St West Memphis AR 72301-2001 Ph: (870) 735-3842 | 1008 W Main St Marvell AR 72366-9486 Ph: (870) 735-3842 |
NPI Number | 1508379249 |
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Provider Enumeration Date | 11/15/2017 |
Last Update Date | 11/18/2020 |
Medicare PECOS PAC ID | 1052390390 |
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Medicare Enrollment ID | O20171127000226 |
Identifier | Type | State | Issuer |
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1508379249 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |