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1923 W Pickens Road Pea Ridge AR 72751 | |
(479) 751-7417 | |
(479) 751-4898 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1923 W Pickens Road, Pea Ridge, 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 |
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614 E Emma Ave Ste 300 Springdale AR 72764-4469 Ph: (479) 751-7417 | 1923 W Pickens Road Pea Ridge AR 72751 Ph: (479) 751-7417 |
NPI Number | 1669099073 |
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Provider Enumeration Date | 07/01/2020 |
Last Update Date | 08/04/2020 |
Medicare PECOS PAC ID | 0042262495 |
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Medicare Enrollment ID | O20200916001627 |
Identifier | Type | State | Issuer |
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1669099073 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |