Basic Information
| Provider Information | |||||||||
| NPI: | 1114578929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS MEDICAL CLINIC ARKANSAS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HARDY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725429566 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 8708562133 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 N VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | WEINER | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724799289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706050014 | ||||||||
| FaxNumber: | 8708952164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2019 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | YORK | ||||||||
| AuthorizedOfficialFirstName: | MONYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5737182570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.