| |
1526 E. Main St. Melbourne AR 72556 | |
(870) 368-4344 | |
(870) 368-3051 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1526 E. Main St., Melbourne, Arkansas |
Authorized Official Name and Position | Shawna Baxter (PROVIDER ENROLLMENT) |
Authorized Official Contact | 8702625545 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1710 Harrison St Batesville AR 72501-7303 Ph: (870) 262-5545 | 1526 E. Main St. Melbourne AR 72556 Ph: (870) 368-4344 |
NPI Number | 1477523348 |
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Provider Enumeration Date | 01/24/2006 |
Last Update Date | 04/29/2024 |
Medicare PECOS PAC ID | 0143134270 |
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Medicare Enrollment ID | O20071205000040 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477523348 | NPI | - | NPPES |
124189729 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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