Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 200 S Main Street, Eudora, Arkansas |
Authorized Official Name and Position | Dewana Little (ADMINISTRATOR) |
Authorized Official Contact | 3184283237 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
706 Ross St Oak Grove LA 71263-9798 Ph: (870) 355-2300 | 200 S Main Street Eudora AR 71640 Ph: (870) 355-2300 |
NPI Number | 1003894395 |
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Provider Enumeration Date | 01/06/2006 |
Last Update Date | 11/06/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1003894395 | NPI | - | NPPES |
150098729 | Medicaid | AR | |
5C962 | Other | AR | ARKANSAS BLUE CROSS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |