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1356345052

NPI Code Detail

MEDICARE: DR. JIMMY DAVID ACKLIN M.D.

MEDICARE: DR. JIMMY DAVID ACKLIN M.D.

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	C-6363	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	080072068	OTHER	AR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4627033	OTHER		AETNA
2	13803000000	OTHER	AR	QUALCHOICE
3	50026	OTHER	AR	BLUE CROSS/BLUE SHIELD
4	6019495001	OTHER		CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	1899432	OTHER	AR	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1356345052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMY DAVID ACKLIN M.D.

Provider Business Mailing Address
First Line	:	612 S 12TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4702
Country	:	US
Telephone Number	:	479-785-2431
Fax Number	:	479-494-7787

Provider Business Practice Location Address
First Line	:	612 S 12TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4702
Country	:	US
Telephone Number	:	479-785-2431
Fax Number	:	479-494-7787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. JIMMY DAVID ACKLIN M.D.” Practice Location

Language	Start Address	Practice Location

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