Larisa Kachowski Family Medicine, Llc | |
1726 W 42d Ave Pine Bluff AR 71603-7160 | |
(501) 502-4071 | |
Not Available |
Full Name | Larisa Kachowski Family Medicine, Llc |
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Speciality | Family Medicine |
Location | 1726 W 42d Ave, Pine Bluff, Arkansas |
Authorized Official Name and Position | Larisa Kachowski (OWNER) |
Authorized Official Contact | 5015024071 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Larisa Kachowski Family Medicine, Llc 3 Stratford Ln Pine Bluff AR 71603-7527 Ph: (501) 502-4071 | Larisa Kachowski Family Medicine, Llc 1726 W 42d Ave Pine Bluff AR 71603-7160 Ph: (501) 502-4071 |
NPI Number | 1376001172 |
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Provider Enumeration Date | 03/11/2019 |
Last Update Date | 04/01/2019 |
Medicare PECOS PAC ID | 1951638923 |
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Medicare Enrollment ID | O20190814000704 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376001172 | NPI | - | NPPES |
1023214574 | Other | AR | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Larisa Kachowski |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1023214574 PECOS PAC ID: 5294885521 Enrollment ID: I20090609000162 |
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