Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 2074 Rice Road, Waldron, Arkansas |
Authorized Official Name and Position | Jerome J White (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 4796350091 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 130 Ratcliff AR 72951-0130 Ph: (479) 635-0091 | 2074 Rice Road Waldron AR 72958 Ph: (479) 635-5300 |
NPI Number | 1992212013 |
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Provider Enumeration Date | 01/10/2018 |
Last Update Date | 02/01/2021 |
Medicare PECOS PAC ID | 0042274276 |
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Medicare Enrollment ID | O20180604001516 |
Identifier | Type | State | Issuer |
---|---|---|---|
1992212013 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |