Provider Demographics
NPI:1700377520
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-994-7301
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-9566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:870-856-2133
Practice Address - Street 1:451 PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774
Practice Address - Country:US
Practice Address - Phone:479-294-6085
Practice Address - Fax:870-895-2164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS MEDICAL CLINIC ARKANSAS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-29
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center