MEDICARE: SOUTHWEST ARKANSAS HEALTHCARE, 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	171W00000X	Contractor	82	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5F344	OTHER	AR	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1275565491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ARKANSAS HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX F
Second Line	:
City	:	MURFREESBORO
State	:	AR
Zip	:	71958-0000
Country	:	US
Telephone Number	:	870-285-3182
Fax Number	:	870-285-3305

Provider Business Practice Location Address
First Line	:	315 EAST 13TH STREET
Second Line	:
City	:	MURFREESBORO
State	:	AR
Zip	:	71958-0000
Country	:	US
Telephone Number	:	870-285-3182
Fax Number	:	870-285-3305

Authorized Official
Title or Position	:	CEO
Name	:	MR. ROBERT R HICKS
Credential	:
Telephone Number	:	870-285-3182

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	01/22/2010

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Directions to “SOUTHWEST ARKANSAS HEALTHCARE, LLC ” Practice Location

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