Mainline Health Systems Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MAINLINE HEALTH SYSTEMS INC

Doing business as

Warren High School Behavioral Health Clinic

Practice address

803 N Walnut St RM 214
Warren, AR 71671-2008

Phone

(870) 226-6754

Fax

(870) 226-7925

NPI assigned

Nov 1, 2023

Last updated

May 15, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Allan Nichols

Title

Ceo

Phone

(870) 942-3000

Specialties & licenses 2

Addresses

Other names 1

• Warren High School Behavioral Health Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215700265. Details of each certification follow.

• CCN 041045 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 041045

Legal name

MAINLINE HEALTH SYSTEMS INC

Doing business as

WARREN HIGH SCHOOL BH CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 12, 2023

Last certification

Dec 12, 2023

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Oct 30, 2023 in AR

Enrollment address

803 N Walnut St
RM 214
Warren, AR 71671-2008

Tax ID family

Sanyasi R Ganta MD35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

• Mainline Health Systems Inc

  dba Sheridan Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Sheridan, AR
  • NPI 1104574219
  NPD tax ID
• Mainline Health Systems Inc

  dba Monticello Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Monticello, AR
  • NPI 1205163540
  NPD tax ID
• Mainline Health Systems Inc

  dba Portland Health Care

  • Federally Qualified Health Center (FQHC)
  • Portland, AR
  • NPI 1316106388
  NPD tax ID
• Mainline Health Systems Inc

  dba Mainline UAM Behavioral Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Monticello, AR
  • NPI 1326717745
  NPD tax ID
• Mainline Health Systems Inc

  dba Mainline Health Systems, Inc- Warren 2

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1396383758
  NPD tax ID
• Mainline Health Systems Inc

  dba Star City Community Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Star City, AR
  • NPI 1649679051
  NPD tax ID
• Mainline Health Systems Inc

  dba Mainline UAM Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Monticello, AR
  • NPI 1861156481
  NPD tax ID
• Mainline Health Systems Inc

  dba Wilmot DRS Clinic

  • Federally Qualified Health Center (FQHC)
  • Wilmot, AR
  • NPI 1891809547
  NPD tax ID
• Mainline Health Systems, Inc

  dba Hamburg High School

  • Federally Qualified Health Center (FQHC)
  • Hamburg, AR
  • NPI 1033584586
  NPD tax ID
• Mainline Health Systems, Inc

  dba Jimmy Brown Elementary

  • Federally Qualified Health Center (FQHC)
  • Star City, AR
  • NPI 1124565213
  NPD tax ID
• Mainline Health Systems, Inc

  dba Star City Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Star City, AR
  • NPI 1154757920
  NPD tax ID
• Mainline Health Systems, Inc

  dba Star City High School Dental

  • Federally Qualified Health Center (FQHC)
  • Star City, AR
  • NPI 1174067888
  NPD tax ID

Locations

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 26

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1215700265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 509",
            "city": "DERMOTT",
            "state": "AR",
            "postal_code": "716380509",
            "telephone_number": "870-942-3000",
            "fax_number": "870-538-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 N WALNUT ST RM 214",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716712008",
            "telephone_number": "870-226-6754",
            "fax_number": "870-226-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-01",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-942-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warren High School Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Warren High School Behavioral Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Madhulika Krish, MD
• Annslie Kathryn Larance
• Rocky Lindsey
• Charles Livingston, LMSW
• Lauren Lynch, PHARMD
• Mainline Health Systems Inc (Mainline Health Systems, Inc- Warren 2)
• Mainline Health Systems, Inc
• Mainline Health Systems, Inc (Warren Elementary School)
• Mainline Health Systems, Inc (Warren Dental Clinic)
• Mainline Health Systems, Inc (Brunson Elementary School)

• Federally Qualified Health Center (FQHC) in Warren, AR
• Providers in Warren, AR by specialty
• Federally Qualified Health Center (FQHC) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.