| Direct MD, LLC | |
|
2223 Grant St Malvern AR 72104-4700 | |
| (501) 337-9031 | |
| Not Available |
| Full Name | Direct MD, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 2223 Grant St, Malvern, Arkansas |
| Authorized Official Name and Position | Kim M Morgan (DIRECTOR CREDENTIALING) |
| Authorized Official Contact | 5019788604 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Direct MD, LLC 1701 S Shackleford Rd Little Rock AR 72211-4335 Ph: (501) 219-7000 | Direct MD, LLC 2223 Grant St Malvern AR 72104-4700 Ph: (501) 337-9031 |
| NPI Number | 1457077356 |
|---|---|
| Provider Enumeration Date | 10/13/2022 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/08/2023 |
| Medicare PECOS PAC ID | 5395116941 |
|---|---|
| Medicare Enrollment ID | O20230119000562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457077356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Dylan Thaxton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609040849 PECOS PAC ID: 6406921667 Enrollment ID: I20080822000210 |
| Provider Name | Shea Don Oxford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205293750 PECOS PAC ID: 6204134059 Enrollment ID: I20160412002381 |
| Provider Name | Cynthia D Durham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902475635 PECOS PAC ID: 2668875550 Enrollment ID: I20210729003181 |
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