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General NPI Number Information
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NPI Number | 1902604945
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Entity Type | Organization
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Legal Business Name | ACCESS MEDICAL CLINIC ARKANSAS LTC LLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1308 E PAGE AVE
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City | MALVERN
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State | AR
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Zip | 72104-4518
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Country | US
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Telephone | 501-337-9820
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Fax | 501-468-0478
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Provider Business Mailing Address
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Address Line | 4196 HIGHWAY 62 412 STE A
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City | HARDY
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State | AR
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Zip | 72542-8002
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Country | US
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Telephone | 870-856-1202
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Fax |
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Authorized Official
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Title or Position | DIRECTOR CREDENTIALING
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Name | MONYA YORK
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Credential |
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Telephone | 870-856-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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