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1500 N Mount Olive St Suite 1 Siloam Springs AR 72761-9509 | |
| (479) 524-8175 | |
| (479) 751-2878 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1500 N Mount Olive St, Siloam Springs, Arkansas |
| Authorized Official Name and Position | James Semingson (CEO) |
| Authorized Official Contact | 4797517417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
614 E Emma Ave Suite 300 Springdale AR 72764-4469 Ph: (479) 751-7417 | 1500 N Mount Olive St Suite 1 Siloam Springs AR 72761-9509 Ph: (479) 524-8175 |
| NPI Number | 1083034029 |
|---|---|
| Provider Enumeration Date | 04/17/2014 |
| Last Update Date | 01/15/2020 |
| Medicare PECOS PAC ID | 0042262495 |
|---|---|
| Medicare Enrollment ID | O20140626000373 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083034029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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