Basic Information
| Provider Information | |||||||||
| NPI: | 1104321850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS MEDICAL CLINIC ARKANSAS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W MAIN ST | ||||||||
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| City: | HARDY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725429566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737182570 | ||||||||
| FaxNumber: | 8708562133 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | CARAWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709560200 | ||||||||
| FaxNumber: | 8708952164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2018 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | BIBB | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8709947301 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ACCESS MEDICAL CLINIC ARKANSAS LLC | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.