| Malvern Diagnostic Clinic | |
|
2223 Grant Street Malvern AR 72104 | |
| (501) 337-9031 | |
| (501) 337-9033 |
| Full Name | Malvern Diagnostic Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 2223 Grant Street, Malvern, Arkansas |
| Authorized Official Name and Position | Bruce Kent Burton (PRESIDENT OWNER) |
| Authorized Official Contact | 5013379031 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Malvern Diagnostic Clinic 2223 Grant Street Malvern AR 72104 Ph: (501) 337-9031 | Malvern Diagnostic Clinic 2223 Grant Street Malvern AR 72104 Ph: (501) 337-9031 |
| NPI Number | 1376639344 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 11/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376639344 | NPI | - | NPPES |
| 110030002 | Medicaid | AR | |
| 57801 | Other | AR | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MC 0784 (Arkansas) | Primary |
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