| |
4900 Kelley Highway Fort Smith AR 72904-5000 | |
(479) 785-5700 | |
(479) 785-5708 |
Full Name | |
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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 |
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Po Box 130 Ratcliff AR 72951-0130 Ph: (479) 635-5300 | 4900 Kelley Highway Fort Smith AR 72904-5000 Ph: (479) 785-5700 |
NPI Number | 1023163193 |
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Provider Enumeration Date | 01/25/2007 |
Last Update Date | 05/15/2023 |
Medicare PECOS PAC ID | 0042274276 |
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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 |
Healthmax Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12300 Highway 71 S, Suite A, Fort Smith, AR 72916 Phone: 479-755-6595 Fax: 479-755-6596 | |
Waldron Place Pediatric Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1501 S Waldron Rd Ste 202, Fort Smith, AR 72903 Phone: 479-452-8311 Fax: 479-452-5032 | |
Remedy Health Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1501 S Waldron Rd Ste 100, Fort Smith, AR 72903 Phone: 479-888-8305 Fax: 918-395-9149 | |