| West Side Wellness | |
|
620 W South St Ste A Benton AR 72015-4235 | |
| (501) 794-6123 | |
| (501) 794-6148 |
| Full Name | West Side Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 620 W South St Ste A, Benton, Arkansas |
| Authorized Official Name and Position | Blake Torres (OWNER) |
| Authorized Official Contact | 5017783151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Side Wellness 620 W South St Ste A Benton AR 72015-4235 Ph: (501) 794-6123 | West Side Wellness 620 W South St Ste A Benton AR 72015-4235 Ph: (501) 794-6123 |
| NPI Number | 1366048803 |
|---|---|
| Provider Enumeration Date | 12/09/2020 |
| Last Update Date | 05/09/2022 |
| Medicare PECOS PAC ID | 1254745920 |
|---|---|
| Medicare Enrollment ID | O20210121001278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366048803 | NPI | - | NPPES |
| 119185001 | Medicaid | AR | |
| 1205911849 | Other | AR | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
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