| Ozark Medical And Pediatric Clinic | |
|
390 Factory Rd Ste B Clinton AR 72031-7088 | |
| (501) 745-3388 | |
| (501) 745-3006 |
| Full Name | Ozark Medical And Pediatric Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 390 Factory Rd Ste B, Clinton, Arkansas |
| Authorized Official Name and Position | Rebecca Gentry (ACCOUNTING SPECIALIST) |
| Authorized Official Contact | 5017459524 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ozark Medical And Pediatric Clinic Po Box 206 Clinton AR 72031-0206 Ph: (501) 745-9524 | Ozark Medical And Pediatric Clinic 390 Factory Rd Ste B Clinton AR 72031-7088 Ph: (501) 745-3388 |
| NPI Number | 1366614935 |
|---|---|
| Provider Enumeration Date | 03/24/2008 |
| Last Update Date | 08/09/2023 |
| Medicare PECOS PAC ID | 2769559848 |
|---|---|
| Medicare Enrollment ID | O20080916000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366614935 | NPI | - | NPPES |
| 186484729 | Medicaid | AR | |
| 169596002 | Medicaid | AR |
| Provider Name | Keith A Coward |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710982871 PECOS PAC ID: 2668430737 Enrollment ID: I20041221000960 |
| Provider Name | Kimberly Blake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689971749 PECOS PAC ID: 0941474738 Enrollment ID: I20111111000667 |
| Provider Name | Brianna C Pate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730453622 PECOS PAC ID: 4486890167 Enrollment ID: I20130425000168 |
| Provider Name | Lisa A Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437526241 PECOS PAC ID: 7810041506 Enrollment ID: I20160218002249 |
| Provider Name | Tanna L Shockley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487191987 PECOS PAC ID: 5496025876 Enrollment ID: I20170718000532 |
| Provider Name | Kayla Michelle Dollar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245738004 PECOS PAC ID: 8921369794 Enrollment ID: I20180220000377 |
| Provider Name | Katherine E Dunham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003579418 PECOS PAC ID: 1254721459 Enrollment ID: I20211202000494 |
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