Provider Demographics
NPI:1376215608
Name:ACCESS MEDICAL CLINIC ARKANSAS LLC
Entity Type:Organization
Organization Name:ACCESS MEDICAL CLINIC ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRED SUPER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:NEELY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-847-7125
Mailing Address - Street 1:4196 HIGHWAY 62 412 STE A
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8002
Mailing Address - Country:US
Mailing Address - Phone:870-856-1202
Mailing Address - Fax:870-856-2107
Practice Address - Street 1:106 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-8059
Practice Address - Country:US
Practice Address - Phone:870-856-1202
Practice Address - Fax:870-856-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty