Provider Demographics
NPI:1891809547
Name:MAINLINE HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:MAINLINE HEALTH SYSTEMS INC
Other - Org Name:WILMOT DRS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-737-2737
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:AR
Mailing Address - Zip Code:71663-0100
Mailing Address - Country:US
Mailing Address - Phone:870-737-2737
Mailing Address - Fax:870-737-9780
Practice Address - Street 1:203 MCCOMB ST
Practice Address - Street 2:
Practice Address - City:WILMOT
Practice Address - State:AR
Practice Address - Zip Code:71676
Practice Address - Country:US
Practice Address - Phone:870-473-2274
Practice Address - Fax:870-473-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122627749Medicaid
AR122627749Medicaid
AR041808Medicare ID - Type Unspecified