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1881652592

NPI Code Detail

MEDICARE: DR. KENNETH MARCUS POEMOCEAH MD

MEDICARE: DR. KENNETH MARCUS POEMOCEAH MD

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	N8028	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00298552	OTHER	AR	RAILROAD MEDICARE

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	54175	OTHER	AR	BCBS (AR)
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881652592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH MARCUS POEMOCEAH MD

Provider Business Mailing Address
First Line	:	1101 JACKSON ST SW
Second Line	:
City	:	GRAVETTE
State	:	AR
Zip	:	72736-9121
Country	:	US
Telephone Number	:	479-787-5221
Fax Number	:	479-787-5613

Provider Business Practice Location Address
First Line	:	1102 JACKSON ST SW
Second Line	:
City	:	GRAVETTE
State	:	AR
Zip	:	72736-9121
Country	:	US
Telephone Number	:	479-787-5221
Fax Number	:	479-787-5613

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	10/16/2023

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Directions to “ DR. KENNETH MARCUS POEMOCEAH MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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