| Sovereign Force, Pa | |
|
301 Sw 16th St Bentonville AR 72712-7173 | |
| (479) 586-9800 | |
| Not Available |
| Full Name | Sovereign Force, Pa |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 301 Sw 16th St, Bentonville, Arkansas |
| Authorized Official Name and Position | Ajdahan D. Bicak (PRESIDENT) |
| Authorized Official Contact | 4795869800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sovereign Force, Pa 301 Sw 16th St Bentonville AR 72712-7173 Ph: (479) 586-9800 | Sovereign Force, Pa 301 Sw 16th St Bentonville AR 72712-7173 Ph: (479) 586-9800 |
| NPI Number | 1629252440 |
|---|---|
| Provider Enumeration Date | 12/28/2007 |
| Last Update Date | 12/28/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629252440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MC-2586 (Arkansas) | Primary |
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