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NPI Code Detail

MEDICARE: MAINLINE HEALTH SYSTEMS, INC

MEDICARE: MAINLINE HEALTH SYSTEMS, 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
1103TB0200XCognitive & Behavioral Psychologist
2261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1972464337
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAINLINE HEALTH SYSTEMS, INC
Provider Business Mailing Address
First Line : 342 HIGHWAY 425 S
Second Line :
City : MONTICELLO
State : AR
Zip : 71655-4612
Country : US
Telephone Number : 870-942-3000
Fax Number : 870-942-3005
Provider Business Practice Location Address
First Line : 1617 N WASHINGTON ST STE 1
Second Line :
City : MAGNOLIA
State : AR
Zip : 71753-2046
Country : US
Telephone Number : 501-451-4110
Fax Number :
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : ELYSE KNOBLOCH
Credential :
Telephone Number : 870-538-5412
Provider Enumeration Date : 11/24/2025
Last Update Date : 05/15/2026

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