| South Fork Health And Wellness Llc | |
|
105 Pinto Place Salem AR 72576-7011 | |
| (870) 500-4225 | |
| Not Available |
| Full Name | South Fork Health And Wellness Llc |
|---|---|
| Speciality | General Practice |
| Location | 105 Pinto Place, Salem, Arkansas |
| Authorized Official Name and Position | Jeffrey Summerhill (OWNER) |
| Authorized Official Contact | 8705004225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Fork Health And Wellness Llc 105 Pinto Place Salem AR 72576-7011 Ph: (870) 500-4225 | South Fork Health And Wellness Llc 105 Pinto Place Salem AR 72576-7011 Ph: (870) 500-4225 |
| NPI Number | 1528731155 |
|---|---|
| Provider Enumeration Date | 07/29/2021 |
| Last Update Date | 07/29/2021 |
| Medicare PECOS PAC ID | 7315311248 |
|---|---|
| Medicare Enrollment ID | O20230316000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528731155 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Summerhill |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1922094432 PECOS PAC ID: 3678472149 Enrollment ID: I20230316000814 |
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