Northeast Arkansas Community Mental Health Center Inc
Organization Active NPI Family Medicine Physician · Blytheville, AR
NPI 1043885759 · NPPES record last updated Apr 22, 2022
Key facts
- NPI
- 1043885759
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
- Practice address
- 209 S Lockard St
Blytheville, AR 72315-2541 - Phone
- (870) 763-2139
- NPI assigned
- May 25, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Authorized official
- Name
- Carla Pratt
- Title
- Business Manager
- Phone
- (870) 972-4016
Other NPIs on the same Medicare enrollment 28
Corporate family (same tax ID) 42
Practitioners 57
-
Natasha Lynn Cassulis, LCSW
-
Tameka Granberry, LCSW
-
Angie D Hicks-Master, ANP
-
Amy Jean Inman, LCSW
-
Brittany Killian, APRN
-
Melissa Michelle Lee, LCSW
-
Kellie Lynn Letbetter, LCSW
-
Allison Melissa McArthur, LCSW
-
Raymond Klein Molden, M.D.
-
Sarah Taylor Newton, LCSW
-
Jessica Sandrell Parker, LCSW
-
Jessica Lane Pipkin, PSY.D.
-
Kenneth Dean Pruett, APN
-
Tisha R Roswell, LCSW
-
George Nixon Shuler Jr., MSW, LCSW
-
Johnathan Clyde Simpson, LCSW
-
Kelli Leann Statler, LCSW
-
Robin Stein, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040110000206 | AR | Part B Supplier - Clinic/Group Practice | 0244130839 |
Receives reassigned benefits from 43 practitioners 29 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Marianna, AR; Pocahontas, AR; Melbourne, AR; Newport, AR; Paragould, AR; Salem, AR; Searcy, AR; Truman, AR… |
National Provider Directory
- Tax ID family
- Northeast Arkansas Community Mental Health Center
- Part of
- Northeast Arkansas Community Mental Health Center
Locations
602 David St
Corning, AR 72422
Phone (870) 857-3655
589 E Main St
Melbourne, AR 72556
Phone (870) 919-8503
1507 N Pecan St
Newport, AR 72112
Phone (866) 533-1758
1011 W Morgan St
Paragould, AR 72450
Phone (870) 239-2244
111 W Booth Rd
Searcy, AR 72143
Phone (870) 919-6320
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
209 S Lockard St
Blytheville, AR 72315-2541
Mailing address
2707 Browns LN
Jonesboro, AR 72401-7213
Other names
- Mid-South Health Systems Inc
Other providers in Blytheville, AR
- Rose Mary Nichols
- Christina L Nicklson
- Brian S Niles
- North Division Street Emergency Physicians
- Northeast Arkansas Community Mental Health Center Inc
- Northeast Arkansas Community Mental Health Center Inc
- Nutritional Care LLC
- Oldham Chiropractic
- Oldham Chiropratic
- Michael C Oldham
All providers in Blytheville, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.