Healthcare Provider Details

I. General information

NPI: 1639702731
Provider Name (Legal Business Name): ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E PAGE AVE
MALVERN AR
72104-4518
US

IV. Provider business mailing address

4196 HIGHWAY 62 412
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 501-337-9820
  • 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: MONYA YORK
Title or Position: CONTROLLER
Credential:
Phone: 870-856-1202