Provider Demographics
NPI:1003894395
Name:WEST CARROLL HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:WEST CARROLL HEALTH SYSTEMS LLC
Other - Org Name:EUDORA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-428-3237
Mailing Address - Street 1:706 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-9798
Mailing Address - Country:US
Mailing Address - Phone:870-355-2300
Mailing Address - Fax:870-355-8363
Practice Address - Street 1:200 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:AR
Practice Address - Zip Code:71640
Practice Address - Country:US
Practice Address - Phone:870-355-2300
Practice Address - Fax:870-355-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150098729Medicaid
AR5C962OtherARKANSAS BLUE CROSS
AR5C962OtherARKANSAS BLUE CROSS