| Southwest Family Practice Clinic | |
|
3417 U Of A Way Texarkana AR 71854-1419 | |
| (870) 779-6000 | |
| (870) 779-6093 |
| Full Name | Southwest Family Practice Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 3417 U Of A Way, Texarkana, Arkansas |
| Authorized Official Name and Position | Amanda D George (VICE CHANCELLOR-CHIEF FINANCIAL OFF) |
| Authorized Official Contact | 5016865670 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwest Family Practice Clinic 3417 U Of A Way Texarkana AR 71854-1419 Ph: (870) 779-6000 | Southwest Family Practice Clinic 3417 U Of A Way Texarkana AR 71854-1419 Ph: (870) 779-6000 |
| NPI Number | 1215935234 |
|---|---|
| Provider Enumeration Date | 07/13/2005 |
| Last Update Date | 07/12/2023 |
| Medicare PECOS PAC ID | 4082528955 |
|---|---|
| Medicare Enrollment ID | O20040129001063 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215935234 | NPI | - | NPPES |
| 092113201 | Medicaid | TX | |
| 213409069 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Arkansas) | Primary |
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
| Provider Name | Michael R Downs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639177959 PECOS PAC ID: 7618865361 Enrollment ID: I20040305000446 |
| Provider Name | Belinda Hutcheson |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1639177728 PECOS PAC ID: 3072588250 Enrollment ID: I20040831001068 |
| Provider Name | Russell E Mayo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568469211 PECOS PAC ID: 8527036573 Enrollment ID: I20040917001130 |
| Provider Name | Matthew W Nix |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184680530 PECOS PAC ID: 7719932839 Enrollment ID: I20050420000638 |
| Provider Name | Kyle Diaz |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063675650 PECOS PAC ID: 8224214200 Enrollment ID: I20110510000282 |
| Provider Name | William Brainerd Ventres |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932251006 PECOS PAC ID: 5395731509 Enrollment ID: I20171030001194 |
| Provider Name | Marjorie Hudson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538697438 PECOS PAC ID: 9537593173 Enrollment ID: I20200107001752 |
| Provider Name | Kenneth G Ross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265752810 PECOS PAC ID: 7416187455 Enrollment ID: I20220808001414 |
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