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NPI Code Detail

MEDICARE: PHILIP C PACKARD ACSW

MEDICARE: PHILIP C PACKARD ACSW
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
11041C0700XClinical Social Worker210-CAR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040971OTHERARMANAGED HEALTH NETWORK
25S094OTHERARBLUE CROSS
3281938OTHERARVALUE OPTIONS

General Provider Information

NPI Number : 1205805116
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP C PACKARD ACSW
Provider Business Mailing Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Provider Business Practice Location Address
First Line : 715 N COLLEGE AVE
Second Line :
City : EL DORADO
State : AR
Zip : 71730-4403
Country : US
Telephone Number : 870-862-7921
Fax Number : 870-864-2490
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 07/08/2007

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