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
1	207Q00000X	Family Medicine Physician
2	208000000X	Pediatrics Physician
3	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1912696923
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	:	4900 20TH AVE
Second Line	:
City	:	VALLEY
State	:	AL
Zip	:	36854-3549
Country	:	US
Telephone Number	:	334-756-5137
Fax Number	:

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

Provider Enumeration Date	:	05/04/2023
Last Update Date	:	03/26/2024

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Directions to “ACCESS MEDICAL CLINIC LLC ” Practice Location

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