MEDICARE: ACCESS MEDICAL CLINIC ARKANSAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1104538388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS MEDICAL CLINIC ARKANSAS LLC

Provider Business Mailing Address
First Line	:	4196 HIGHWAY 62 412
Second Line	:
City	:	HARDY
State	:	AR
Zip	:	72542-8002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 N WASHINGTON ST
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-2121
Country	:	US
Telephone Number	:	870-594-6001
Fax Number	:	501-823-3623

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MONYA YORK
Credential	:
Telephone Number	:	870-856-1202

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	10/23/2023

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