| The Centers Medical Clinic, Llc | |
|
1521 Merrill Drive Suite D240 Little Rock AR 72211-1821 | |
| (501) 660-6893 | |
| (501) 954-7798 |
| Full Name | The Centers Medical Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1521 Merrill Drive, Little Rock, Arkansas |
| Authorized Official Name and Position | Barbara Mccrory (COO) |
| Authorized Official Contact | 5016668686 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Centers Medical Clinic, Llc P.o. Box 251970 Little Rock AR 72225-1970 Ph: (501) 666-8686 | The Centers Medical Clinic, Llc 1521 Merrill Drive Suite D240 Little Rock AR 72211-1821 Ph: (501) 660-6893 |
| NPI Number | 1518625201 |
|---|---|
| Provider Enumeration Date | 11/30/2021 |
| Last Update Date | 05/18/2023 |
| Medicare PECOS PAC ID | 3870975865 |
|---|---|
| Medicare Enrollment ID | O20230127000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518625201 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Michael T Kittell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659523124 PECOS PAC ID: 9931264751 Enrollment ID: I20090211000413 |
| Provider Name | Amy E Backus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851737787 PECOS PAC ID: 1456580588 Enrollment ID: I20140212000409 |
| Provider Name | Katia Rayburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740870583 PECOS PAC ID: 8123412699 Enrollment ID: I20220225001827 |
| Provider Name | Thomas Richard Degraff |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1003002510 PECOS PAC ID: 7012199425 Enrollment ID: I20230209001563 |
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