| Lee County Cooperative Clinic | |
|
530 West Atkins Blvd Marianna AR 72360-2113 | |
| (870) 295-5225 | |
| (870) 295-6900 |
| Full Name | Lee County Cooperative Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 530 West Atkins Blvd, Marianna, Arkansas |
| Authorized Official Name and Position | Ossie M Hall (CASHIER/BILLING SUPERVISOR) |
| Authorized Official Contact | 8702955225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lee County Cooperative Clinic Po Box 669 Marianna AR 72360-0669 Ph: (870) 295-5225 | Lee County Cooperative Clinic 530 West Atkins Blvd Marianna AR 72360-2113 Ph: (870) 295-5225 |
| NPI Number | 1669480836 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 09/21/2021 |
| Medicare PECOS PAC ID | 8921917204 |
|---|---|
| Medicare Enrollment ID | O20081213000190 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669480836 | NPI | - | NPPES |
| 117597749 | Medicaid | AR | |
| 5G122 | Other | AR | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Prabhakara Tukivakala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659474161 PECOS PAC ID: 2567439250 Enrollment ID: I20050104001109 |
| Provider Name | Jacquolyn Jo Early |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134257967 PECOS PAC ID: 2062462682 Enrollment ID: I20050131000837 |
| Provider Name | Thomas O Bailey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851403422 PECOS PAC ID: 0547366395 Enrollment ID: I20070510000600 |
| Provider Name | Harry A. Michel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245491380 PECOS PAC ID: 1658549787 Enrollment ID: I20110715000548 |
| Provider Name | Keisha A Fox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033765490 PECOS PAC ID: 5294159547 Enrollment ID: I20200904001410 |
| Provider Name | Brittany Mitchell |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1447863147 PECOS PAC ID: 8628483682 Enrollment ID: I20210225000537 |
| Provider Name | Stephanie Glenn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457930497 PECOS PAC ID: 5395138044 Enrollment ID: I20220202000917 |
| Provider Name | Elizabeth Anne Barnes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174256770 PECOS PAC ID: 3779950399 Enrollment ID: I20221110000568 |
Marianna Medical Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 N Poplar St, Marianna, AR 72360 Phone: 870-295-3430 | |
Marianna Family Medicine Clinic Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 29 West Tennessee Street, Marianna, AR 72360 Phone: 870-295-2543 Fax: 870-295-4634 |