Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 509 Jackson St, Madison, 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 |
---|---|
Po Box 669 Marianna AR 72360-0669 Ph: (870) 295-5225 | 509 Jackson St Madison AR 72359 Ph: (870) 295-5225 |
NPI Number | 1679581532 |
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Provider Enumeration Date | 08/04/2006 |
Last Update Date | 03/11/2021 |
Medicare PECOS PAC ID | 8921917204 |
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Medicare Enrollment ID | O20100818000433 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679581532 | NPI | - | NPPES |
125273749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |