Basic Information
| Provider Information | |||||||||
| NPI: | 1790375541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS MEDICAL CLINIC ARKANSAS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4196 HIGHWAY 62 412 STE A | ||||||||
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| City: | HARDY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725428002 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 8708562107 | ||||||||
| Practice Location | |||||||||
| Address1: | 11885 HIGHWAY 49 N | ||||||||
| Address2: | |||||||||
| City: | MARMADUKE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724439596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705659205 | ||||||||
| FaxNumber: | 8708952164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2021 | ||||||||
| LastUpdateDate: | 04/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | YORK | ||||||||
| AuthorizedOfficialFirstName: | MONYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 8708561202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.