| Mainline Health Systems, Inc- Warren 2 | |
|
1012 E Church St Ste B Warren AR 71671-3530 | |
| (870) 226-6754 | |
| (870) 226-7925 |
| Full Name | Mainline Health Systems, Inc- Warren 2 |
|---|---|
| Speciality | Clinic/Center |
| Location | 1012 E Church St Ste B, Warren, Arkansas |
| Authorized Official Name and Position | Gary Allan Nichols (CEO) |
| Authorized Official Contact | 8709423000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mainline Health Systems, Inc- Warren 2 Po Box 509 Dermott AR 71638-0509 Ph: (870) 942-3000 | Mainline Health Systems, Inc- Warren 2 1012 E Church St Ste B Warren AR 71671-3530 Ph: (870) 226-6754 |
| NPI Number | 1396383758 |
|---|---|
| Provider Enumeration Date | 12/17/2019 |
| Last Update Date | 07/10/2024 |
| Medicare PECOS PAC ID | 5193785590 |
|---|---|
| Medicare Enrollment ID | O20200113001949 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396383758 | NPI | - | NPPES |
| 240737749 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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