Healthcare Provider Details

I. General information

NPI: 1902604945
Provider Name (Legal Business Name): ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
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 STE A
HARDY AR
72542-8002
US

V. Phone/Fax

Practice location:
  • Phone: 501-337-9820
  • Fax: 501-468-0478
Mailing address:
  • Phone: 870-856-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MONYA YORK
Title or Position: DIRECTOR CREDENTIALING
Credential:
Phone: 870-856-1202