| Scott R. Nichols M.d. P.a. | |
|
3801 Camden Rd # 22 Pine Bluff AR 71603-4612 | |
| (870) 879-3517 | |
| Not Available |
| Full Name | Scott R. Nichols M.d. P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 3801 Camden Rd # 22, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Scott R Nichols (OWNER) |
| Authorized Official Contact | 8708793517 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scott R. Nichols M.d. P.a. 3801 Camden Rd # 22 Pine Bluff AR 71603-4612 Ph: (870) 879-3517 | Scott R. Nichols M.d. P.a. 3801 Camden Rd # 22 Pine Bluff AR 71603-4612 Ph: (870) 879-3517 |
| NPI Number | 1861624330 |
|---|---|
| Provider Enumeration Date | 08/18/2009 |
| Last Update Date | 11/13/2015 |
| Medicare PECOS PAC ID | 3971659160 |
|---|---|
| Medicare Enrollment ID | O20090912000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861624330 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C6461 (Arkansas) | Primary |
| Provider Name | Scott R Nichols |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275577280 PECOS PAC ID: 4183726441 Enrollment ID: I20070216000667 |
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