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General NPI Number Information
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NPI Number | 1437960929
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Entity Type | Organization
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Legal Business Name | MAINLINE HEALTH SYSTEMS, INC
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 700 MAIN ST
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City | RISON
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State | AR
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Zip | 71665-9563
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Country | US
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Telephone | 870-325-6255
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Fax | 870-325-6117
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Provider Business Mailing Address
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Address Line | PO BOX 509
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City | DERMOTT
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State | AR
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Zip | 71638-0509
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Country | US
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Telephone | 870-942-3000
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Fax | 870-538-5412
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ELYSE KNOBLOCH
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Credential | CPA
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Telephone | 870-942-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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