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 |
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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 |
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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 |
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Provider Enumeration Date | 07/13/2005 |
Last Update Date | 07/12/2023 |
Medicare PECOS PAC ID | 4082528955 |
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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 |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1639177959 PECOS PAC ID: 7618865361 Enrollment ID: I20040305000446 |
Provider Name | Belinda Hutcheson |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1639177728 PECOS PAC ID: 3072588250 Enrollment ID: I20040831001068 |
Provider Name | Russell E Mayo |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1568469211 PECOS PAC ID: 8527036573 Enrollment ID: I20040917001130 |
Provider Name | Matthew W Nix |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1184680530 PECOS PAC ID: 7719932839 Enrollment ID: I20050420000638 |
Provider Name | Kyle Diaz |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1063675650 PECOS PAC ID: 8224214200 Enrollment ID: I20110510000282 |
Provider Name | William Brainerd Ventres |
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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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