| |
400 E Arkansas St Rm E3 Star City AR 71667-4821 | |
(650) 419-2810 | |
(870) 538-5412 |
Full Name | |
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Speciality | Clinic/Center |
Location | 400 E Arkansas St Rm E3, Star City, Arkansas |
Authorized Official Name and Position | Gary Allan Nichols (CEO) |
Authorized Official Contact | 8709423000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 509 Dermott AR 71638-0509 Ph: (870) 942-3000 | 400 E Arkansas St Rm E3 Star City AR 71667-4821 Ph: (650) 419-2810 |
NPI Number | 1295277010 |
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Provider Enumeration Date | 11/10/2016 |
Last Update Date | 07/10/2024 |
Medicare PECOS PAC ID | 5193785590 |
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Medicare Enrollment ID | O20170404001117 |
Identifier | Type | State | Issuer |
---|---|---|---|
1295277010 | NPI | - | NPPES |
219121749 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Kenneth A Heiles, D.o. Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 203 S Jefferson St, Star City, AR 71667 Phone: 870-628-5110 Fax: 870-628-5949 | |
Paul F Whipple,d.o.,p.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 557 Kirkwood Rd, Star City, AR 71667 Phone: 870-628-5391 Fax: 870-629-5393 | |