Healthcare Provider Details

I. General information

NPI: 1164913984
Provider Name (Legal Business Name): ACCESS MEDICAL CLINIC ARKANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 N HWY 59
CEDARVILLE AR
72932-9621
US

IV. Provider business mailing address

101 W MAIN ST
HARDY AR
72542-9566
US

V. Phone/Fax

Practice location:
  • Phone: 479-262-2244
  • Fax: 870-895-2164
Mailing address:
  • Phone:
  • Fax: 870-856-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY RAY BIBB
Title or Position: CEO
Credential: MD
Phone: 870-994-7301