| Pni Dba Jacksonville Medical Clinic | |
|
1300 Braden St Jacksonville AR 72076-3719 | |
| (501) 985-5900 | |
| (501) 985-6016 |
| Full Name | Pni Dba Jacksonville Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1300 Braden St, Jacksonville, Arkansas |
| Authorized Official Name and Position | Julian Dale Calhoon (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5019855900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pni Dba Jacksonville Medical Clinic Po Box 309 Jacksonville AR 72078-0309 Ph: (501) 985-5900 | Pni Dba Jacksonville Medical Clinic 1300 Braden St Jacksonville AR 72076-3719 Ph: (501) 985-5900 |
| NPI Number | 1689679169 |
|---|---|
| Provider Enumeration Date | 06/20/2005 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689679169 | NPI | - | NPPES |
| 142734002 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Arkansas) | Primary |
| 207R00000X | Internal Medicine | (Arkansas) | Secondary |
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