| Russellville Branch | |
|
210 N Shamrock Blvd Russellville AR 72802-9658 | |
| (479) 968-2263 | |
| Not Available |
| Full Name | Russellville Branch |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 210 N Shamrock Blvd, Russellville, Arkansas |
| Authorized Official Name and Position | Rolando Garcia (CFO) |
| Authorized Official Contact | 5013153344 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russellville Branch Po Box 1589 Benton AR 72018-1589 Ph: (501) 315-3344 | Russellville Branch 210 N Shamrock Blvd Russellville AR 72802-9658 Ph: (479) 968-2263 |
| NPI Number | 1831349851 |
|---|---|
| Provider Enumeration Date | 09/26/2008 |
| Last Update Date | 03/12/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831349851 | NPI | - | NPPES |
| 171623526 | Medicaid | AR | |
| 116374726 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Arkansas) | Primary |
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Tracy Tullos Southern Therapy Specialists Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 701 E Main St, Suite 2, Russellville, AR 72801 Phone: 479-576-2799 | |
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