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NPI Code Detail

MEDICARE: MAINLINE HEALTH SYSTEMS, INC

MEDICARE: MAINLINE HEALTH SYSTEMS, 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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154757920
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAINLINE HEALTH SYSTEMS, INC
Provider Business Mailing Address
First Line : PO BOX 509
Second Line :
City : DERMOTT
State : AR
Zip : 71638-0509
Country : US
Telephone Number : 870-942-3000
Fax Number : 870-538-5412
Provider Business Practice Location Address
First Line : 110 N DREW ST
Second Line :
City : STAR CITY
State : AR
Zip : 71667-5704
Country : US
Telephone Number : 870-628-5110
Fax Number : 855-854-6281
Authorized Official
Title or Position : CEO
Name : GARY A NICHOLS
Credential :
Telephone Number : 870-942-3000
Provider Enumeration Date : 09/24/2013
Last Update Date : 05/15/2025

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Directions to “MAINLINE HEALTH SYSTEMS, INC ” Practice Location

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