| R Keith Davis Md Pllc Pa | |
|
1400 Pershing Hwy Smackover AR 71762-2300 | |
| (870) 725-3471 | |
| (870) 725-3215 |
| Full Name | R Keith Davis Md Pllc Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 Pershing Hwy, Smackover, Arkansas |
| Authorized Official Name and Position | Richard K Davis (SOLE MEMBER) |
| Authorized Official Contact | 8707253471 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R Keith Davis Md Pllc Pa Po Box 69 Smackover AR 71762-0069 Ph: (870) 725-3471 | R Keith Davis Md Pllc Pa 1400 Pershing Hwy Smackover AR 71762-2300 Ph: (870) 725-3471 |
| NPI Number | 1659604064 |
|---|---|
| Provider Enumeration Date | 09/16/2009 |
| Last Update Date | 09/23/2009 |
| Medicare PECOS PAC ID | 3173669199 |
|---|---|
| Medicare Enrollment ID | O20091006000184 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659604064 | NPI | - | NPPES |
| 145479001 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | E3055 (Arkansas) | Primary |
| Provider Name | Richard Keith Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104826320 PECOS PAC ID: 8224923966 Enrollment ID: I20040220000216 |
| Provider Name | Karen Everett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972855161 PECOS PAC ID: 2567614811 Enrollment ID: I20121212000487 |
| Provider Name | Tanya M Golden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275071755 PECOS PAC ID: 0345525127 Enrollment ID: I20170316002497 |
Richard K Davis Md Pllc Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1400 Pershing Hwy, Smackover, AR 71762 Phone: 870-725-3471 Fax: 870-725-3215 | |
R Keith Davis Md Pllc Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 727 Buckaroo Ln, Smackover, AR 71762 Phone: 870-725-3471 Fax: 870-725-3041 | |
Clint A Netherland, Md, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1400 Pershing Hwy, Smackover, AR 71762 Phone: 870-725-3471 Fax: 870-725-3041 |