Full Name | |
---|---|
Speciality | Clinic/center - Rural Health |
Location | 1008 Main St, Marvell, Arkansas |
Authorized Official Name and Position | Laura Holsford (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 6154657466 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 848092 Dallas TX 75284-8092 Ph: () - | 1008 Main St Marvell AR 72366 Ph: (870) 829-2521 |
NPI Number | 1588632582 |
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Provider Enumeration Date | 03/08/2006 |
Last Update Date | 06/19/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588632582 | NPI | - | NPPES |
1495414729 | Medicaid | AR | |
10085 | Other | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |