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NPI Code Detail

MEDICARE: THE GREGORY KISTLER TREATMENT CENTER, INC.

MEDICARE: THE GREGORY KISTLER TREATMENT CENTER, 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
1251V00000XVoluntary or Charitable Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
247953OTHERARBCBS DME
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
55B311OTHERARBCBS TREATMENT

General Provider Information

NPI Number : 1437118015
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE GREGORY KISTLER TREATMENT CENTER, INC.
Provider Business Mailing Address
First Line : 3304 S M ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-2903
Country : US
Telephone Number : 479-785-4677
Fax Number : 479-785-4673
Provider Business Practice Location Address
First Line : 3304 S M ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-2903
Country : US
Telephone Number : 479-785-4677
Fax Number : 479-785-4673
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. JENNIFER KISTLER
Credential :
Telephone Number : 479-785-4677
Provider Enumeration Date : 03/21/2006
Last Update Date : 08/13/2012

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