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General NPI Number Information
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NPI Number | 1952405524
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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 | 09/12/2006
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 203 MCCOMB ST
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City | WILMOT
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State | AR
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Zip | 71676
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Country | US
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Telephone | 870-473-2274
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Fax | 870-473-5392
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | PORTLAND
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State | AR
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Zip | 71663-0100
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Country | US
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Telephone | 870-737-2737
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Fax | 870-737-9780
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Authorized Official
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Title or Position | CEO
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Name | GARY ALLAN NICHOLS
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Credential |
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Telephone | 870-538-5414
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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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