| Mary Annette Pugh Md, Pllc | |
|
2500 Highway 65 S Clinton AR 72031-6588 | |
| (479) 979-8064 | |
| (479) 219-5500 |
| Full Name | Mary Annette Pugh Md, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 2500 Highway 65 S, Clinton, Arkansas |
| Authorized Official Name and Position | Mary Pugh (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4798064290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Annette Pugh Md, Pllc Po Box 9178 Russellville AR 72811-9178 Ph: (800) 824-4094 | Mary Annette Pugh Md, Pllc 2500 Highway 65 S Clinton AR 72031-6588 Ph: (479) 979-8064 |
| NPI Number | 1710365382 |
|---|---|
| Provider Enumeration Date | 05/14/2015 |
| Last Update Date | 04/09/2021 |
| Medicare PECOS PAC ID | 6901112259 |
|---|---|
| Medicare Enrollment ID | O20150901000867 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710365382 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Mary A Pugh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831359082 PECOS PAC ID: 9739360504 Enrollment ID: I20140613000416 |
| Provider Name | Wanda M Lewis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346731866 PECOS PAC ID: 8729336599 Enrollment ID: I20190516002757 |
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