| Med79 | |
|
2304 W 29th Ave Pine Bluff AR 71603-5005 | |
| (501) 804-5628 | |
| Not Available |
| Full Name | Med79 |
|---|---|
| Speciality | Family Medicine |
| Location | 2304 W 29th Ave, Pine Bluff, Arkansas |
| Authorized Official Name and Position | Christopher Keith Mcdaniel (CEO) |
| Authorized Official Contact | 5018045628 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Med79 3805 Winters Pl Pine Bluff AR 71603-6413 Ph: (501) 804-5628 | Med79 2304 W 29th Ave Pine Bluff AR 71603-5005 Ph: (501) 804-5628 |
| NPI Number | 1356117626 |
|---|---|
| Provider Enumeration Date | 11/28/2023 |
| Last Update Date | 11/28/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356117626 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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