Healthcare Provider Details

I. General information

NPI: 1306753975
Provider Name (Legal Business Name): MAINLINE HEALTH SYSTEMS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 E ARKANSAS ST
STAR CITY AR
71667-4842
US

IV. Provider business mailing address

342 HIGHWAY 425 S
MONTICELLO AR
71655-4612
US

V. Phone/Fax

Practice location:
  • Phone: 870-628-5110
  • Fax: 855-854-6281
Mailing address:
  • Phone: 870-942-3000
  • Fax: 870-942-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ELYSE KNOBLOCH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 870-538-5412