MEDICARE: METRO SPRINGDALE TREATMENT CENTER, INC

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	261Q00000X	Clinic/Center	0602898	AR

General Provider Information

NPI Number	:	1104841600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO SPRINGDALE TREATMENT CENTER, INC

Provider Business Mailing Address
First Line	:	1670 W SUNSET AVE
Second Line	:	STE B
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5136
Country	:	US
Telephone Number	:	479-725-2555
Fax Number	:	479-725-2562

Provider Business Practice Location Address
First Line	:	1670 W SUNSET AVE
Second Line	:	STE B
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-5136
Country	:	US
Telephone Number	:	479-725-2555
Fax Number	:	479-725-2562

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL E DICKERSON
Credential	:
Telephone Number	:	316-200-4424

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/22/2020

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