| Salem Family Practice Clinic,pa | |
|
6640 Congo Rd Benton AR 72019-6913 | |
| (501) 794-4110 | |
| (501) 316-9360 |
| Full Name | Salem Family Practice Clinic,pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 6640 Congo Rd, Benton, Arkansas |
| Authorized Official Name and Position | Patricia G Mcgarry (PHYSICIAN OWNER) |
| Authorized Official Contact | 5017944110 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Salem Family Practice Clinic,pa 6640 Congo Rd Benton AR 72019-6913 Ph: (501) 794-4110 | Salem Family Practice Clinic,pa 6640 Congo Rd Benton AR 72019-6913 Ph: (501) 794-4110 |
| NPI Number | 1578591129 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 11/16/2007 |
| Medicare PECOS PAC ID | 3375554165 |
|---|---|
| Medicare Enrollment ID | O20071101000741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578591129 | NPI | - | NPPES |
| 5F075 | Other | AR | BCBS |
| 5F075 | Other | AR | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | MC1718 (Arkansas) | Primary |
| Provider Name | Patricia G Mcgarry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891816153 PECOS PAC ID: 8325069271 Enrollment ID: I20051207000937 |
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