| Larisa Kachowski Family Medicine, Llc | |
|
1726 W 42d Ave Pine Bluff AR 71603-7160 | |
| (501) 502-4071 | |
| Not Available |
| Full Name | Larisa Kachowski Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1726 W 42d Ave, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Larisa Kachowski (OWNER) |
| Authorized Official Contact | 5015024071 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Larisa Kachowski Family Medicine, Llc 3 Stratford Ln Pine Bluff AR 71603-7527 Ph: (501) 502-4071 | Larisa Kachowski Family Medicine, Llc 1726 W 42d Ave Pine Bluff AR 71603-7160 Ph: (501) 502-4071 |
| NPI Number | 1376001172 |
|---|---|
| Provider Enumeration Date | 03/11/2019 |
| Last Update Date | 04/01/2019 |
| Medicare PECOS PAC ID | 1951638923 |
|---|---|
| Medicare Enrollment ID | O20190814000704 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376001172 | NPI | - | NPPES |
| 1023214574 | Other | AR | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Larisa Kachowski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023214574 PECOS PAC ID: 5294885521 Enrollment ID: I20090609000162 |
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