Provider Demographics
NPI:1942400312
Name:MEMORY MEDICAL
Entity Type:Organization
Organization Name:MEMORY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-420-7476
Mailing Address - Street 1:129 N VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-0524
Mailing Address - Country:US
Mailing Address - Phone:479-530-1771
Mailing Address - Fax:
Practice Address - Street 1:129 N VAUGHN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-0524
Practice Address - Country:US
Practice Address - Phone:479-530-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1863302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5-M214Medicare PIN