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General NPI Number Information
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NPI Number | 1972464337
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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 | 11/24/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1617 N WASHINGTON ST STE 1
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City | MAGNOLIA
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State | AR
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Zip | 71753-2046
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Country | US
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Telephone | 501-451-4110
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Fax |
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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 |
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Fax |
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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 |
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Telephone | 870-538-5412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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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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