| Rvpcs Northside Clinic | |
|
4900 Kelley Highway Fort Smith AR 72904-5000 | |
| (479) 785-5700 | |
| (479) 785-5708 |
| Full Name | Rvpcs Northside Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4900 Kelley Highway, Fort Smith, Arkansas |
| Authorized Official Name and Position | Jerome Joseph White (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4794312057 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rvpcs Northside Clinic Po Box 130 Ratcliff AR 72951-0130 Ph: (479) 635-5300 | Rvpcs Northside Clinic 4900 Kelley Highway Fort Smith AR 72904-5000 Ph: (479) 785-5700 |
| NPI Number | 1023163193 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 05/15/2023 |
| Medicare PECOS PAC ID | 0042274276 |
|---|---|
| Medicare Enrollment ID | O20061213000644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023163193 | NPI | - | NPPES |
| 770106349 | Medicaid | AR | |
| 1255357794 | Medicaid | AR | |
| 162672749 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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