| Premier Family Health Care LLC | |
|
310 N Progress Ave Siloam Springs AR 72761-4093 | |
| (479) 225-5429 | |
| Not Available |
| Full Name | Premier Family Health Care LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 310 N Progress Ave, Siloam Springs, Arkansas |
| Authorized Official Name and Position | Tracey Moore (MEMBER) |
| Authorized Official Contact | 4792255429 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Family Health Care LLC 11005 N Wedington Blacktop Rd Lincoln AR 72744-9459 | Premier Family Health Care LLC 310 N Progress Ave Siloam Springs AR 72761-4093 Ph: (479) 225-5429 |
| NPI Number | 1558102228 |
|---|---|
| Provider Enumeration Date | 06/05/2024 |
| Last Update Date | 12/06/2024 |
| Certification Date | 12/06/2024 |
| Medicare PECOS PAC ID | 8820535545 |
|---|---|
| Medicare Enrollment ID | O20240731000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558102228 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| 363A00000X | Physician Assistant | () | Secondary |
| 363L00000X | Nurse Practitioner | () | Secondary |
| Provider Name | Amelia Dee Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093105918 PECOS PAC ID: 4486970183 Enrollment ID: I20150223001527 |
| Provider Name | Willard H Howard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487609541 PECOS PAC ID: 3779551106 Enrollment ID: I20160428000728 |
| Provider Name | Joshua D Merriman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558779710 PECOS PAC ID: 7012137631 Enrollment ID: I20180907001742 |
| Provider Name | Emory Klindworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700403946 PECOS PAC ID: 0244656957 Enrollment ID: I20200812001006 |
| Provider Name | Kasilynn Alese Shaddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144836909 PECOS PAC ID: 2466872031 Enrollment ID: I20201020002442 |
| Provider Name | Bridget M Mcclelland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700651742 PECOS PAC ID: 9335599257 Enrollment ID: I20240219000273 |
| Provider Name | Drew Hampton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780403048 PECOS PAC ID: 5496289787 Enrollment ID: I20241108002191 |
| Provider Name | Ana Salazar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477374973 PECOS PAC ID: 3577090372 Enrollment ID: I20241218000408 |
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