| Face 2 Face Pllc | |
|
1306 Sylvan Hills Rd Van Buren AR 72956-2565 | |
| (479) 208-3471 | |
| (888) 987-1841 |
| Full Name | Face 2 Face Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1306 Sylvan Hills Rd, Van Buren, Arkansas |
| Authorized Official Name and Position | Jonathan Rene Broniste (OWNER) |
| Authorized Official Contact | 4792083471 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Face 2 Face Pllc Po Box 140 Lavaca AR 72941-0140 Ph: (479) 674-9181 | Face 2 Face Pllc 1306 Sylvan Hills Rd Van Buren AR 72956-2565 Ph: (479) 208-3471 |
| NPI Number | 1730425448 |
|---|---|
| Provider Enumeration Date | 12/27/2012 |
| Last Update Date | 09/16/2019 |
| Medicare PECOS PAC ID | 9032355649 |
|---|---|
| Medicare Enrollment ID | O20130425000616 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730425448 | NPI | - | NPPES |
| 198286004 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Carolyn M Dillard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396790721 PECOS PAC ID: 0345227807 Enrollment ID: I20040701001375 |
| Provider Name | Jonathan R Broniste |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275774440 PECOS PAC ID: 4587790936 Enrollment ID: I20100325000106 |
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