Basic Information
| Provider Information | |||||||||
| NPI: | 1780246959 | ||||||||
| 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 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 WILSON FARM RD | ||||||||
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| City: | GREENBRIER | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016798970 | ||||||||
| FaxNumber: | 8708952164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2019 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | BIBB | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8709947301 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.