MEDICARE: ACCESS MEDICAL CLINIC 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

General Provider Information

NPI Number	:	1215891098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS MEDICAL CLINIC LLC

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

Provider Business Practice Location Address
First Line	:	120 TANNER PL
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-6684
Country	:	US
Telephone Number	:	865-855-3500
Fax Number	:	865-855-4500

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

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	02/12/2026

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