Healthcare Provider Details

I. General information

NPI: 1124539648
Provider Name (Legal Business Name): ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 NORTH FOURCHE AVENUE
PERRYVILLE AR
72126
US

IV. Provider business mailing address

101 W MAIN ST
HARDY AR
72542-9566
US

V. Phone/Fax

Practice location:
  • Phone: 501-238-1284
  • Fax:
Mailing address:
  • Phone: 573-718-2570
  • Fax:

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