| Primary Care Of Arkansas Chrystal Johnson Md | |
|
500 S University Ave Suite 515 Little Rock AR 72205-5302 | |
| (501) 666-6100 | |
| (501) 666-6107 |
| Full Name | Primary Care Of Arkansas Chrystal Johnson Md |
|---|---|
| Speciality | Family Medicine |
| Location | 500 S University Ave, Little Rock, Arkansas |
| Authorized Official Name and Position | Chrystal Dian Johnson (OWNER) |
| Authorized Official Contact | 5016666100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Of Arkansas Chrystal Johnson Md 500 S University Ave Suite 515 Little Rock AR 72205-5302 Ph: (501) 666-6100 | Primary Care Of Arkansas Chrystal Johnson Md 500 S University Ave Suite 515 Little Rock AR 72205-5302 Ph: (501) 666-6100 |
| NPI Number | 1013161363 |
|---|---|
| Provider Enumeration Date | 11/13/2008 |
| Last Update Date | 10/17/2014 |
| Medicare PECOS PAC ID | 6800956608 |
|---|---|
| Medicare Enrollment ID | O20081125000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013161363 | NPI | - | NPPES |
| 150345001 | Medicaid | AR | |
| 181136002 | Medicaid | AR | |
| 04010017400 | Other | AR | QUAL CHOICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Chrystal Dian Johnson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497836563 PECOS PAC ID: 7719872035 Enrollment ID: I20040217000187 |
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