| Community Clinic Fayetteville Medical | |
|
3162 W Martin Luther King Blvd Suites 13 & 14 Fayetteville AR 72704-7684 | |
| (479) 935-4834 | |
| (479) 751-2878 |
| Full Name | Community Clinic Fayetteville Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 3162 W Martin Luther King Blvd, Fayetteville, Arkansas |
| Authorized Official Name and Position | James Semingson (CEO) |
| Authorized Official Contact | 4797517417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Clinic Fayetteville Medical 614 E Emma Ave Suite 300 Springdale AR 72764-4634 Ph: (479) 751-7417 | Community Clinic Fayetteville Medical 3162 W Martin Luther King Blvd Suites 13 & 14 Fayetteville AR 72704-7684 Ph: (479) 935-4834 |
| NPI Number | 1013384288 |
|---|---|
| Provider Enumeration Date | 08/24/2015 |
| Last Update Date | 01/15/2020 |
| Medicare PECOS PAC ID | 0042262495 |
|---|---|
| Medicare Enrollment ID | O20160114000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013384288 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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