Access Medical Clinic Arkansas LLC
Organization Active NPI Rural Health Clinic/Center · Viola, AR
NPI 1346869419 · NPPES record last updated Dec 11, 2020
Key facts
- NPI
- 1346869419
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ACCESS MEDICAL CLINIC ARKANSAS LLC
- Practice address
- 9798 Highway 62 W
Viola, AR 72583-6001 - Phone
- (870) 458-6732
- Fax
- (870) 895-2164
- NPI assigned
- Apr 9, 2020
- Organization subpart
- No
Authorized official
- Name
- Monya York
- Title
- Administrative Credentialing
- Phone
- (870) 856-1202
Owners & managing parties with NPI records 2
-
Randi L Davis, APRN
-
Mark S Hahn, DO
Other NPIs on the same Medicare enrollment 43
Corporate family (same tax ID) 19
Practitioners 43
-
Sheri N. Davis, A.P.R.N., FNP-C
-
John Scribner, M.D.
-
Sara Bayird, APRN
-
Verona Tice Brown-Bebow, M.D.
-
Kimberly Dawn Burner, M.D.
-
Rebecca Coble, APRN, FNP-C
-
Staci Rachelle Cochran, FNP-C
-
Randi L Davis, APRN
-
Stephanie Eagle, FNP-BC
-
Alisha Engelkes, APRN
-
David Glenn Fulghum, FNP-BC
-
Alicia Marie Gates, DNP
-
Linzy Gavin, APRN
-
Mark S Hahn, DO
-
Whitley Erin Harris, APRN
-
Laura Michelle Hernandez, APRN, FNP-C
-
Darla Ann Johnston, APRN, FNP-C
-
Priscilla Jo Johnston, APRN
-
Brandi Lee Jones, APRN
-
Jamye Nichole Jones, APRN
-
Charity Angela Lane, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Rural health clinic certification: CCN 043911
- Legal name
- ACCESS MEDICAL CLINIC ARKANSAS LLC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 28, 2020
- Last certification
- Sep 28, 2020
- Ownership / control type
- 1C
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 2, 2016 in AR
- Enrollment address
- 9798 Highway 62 W
Viola, AR 72583-6001
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Howard Freeman |
Corporate Director |
May 18, 2026 | |
| W-2 Managing Employee |
May 18, 2026 | ||
| Operational/Managerial Control |
May 18, 2026 | ||
| Mark Hahn |
5% Or Greater Direct Ownership Interest | May 8, 2025 | |
| Corporate Director |
May 8, 2025 | ||
| Tony D James |
Corporate Officer |
May 18, 2026 | |
| W-2 Managing Employee |
May 18, 2026 | ||
| Jared Clifford |
Corporate Officer |
May 18, 2026 | |
| W-2 Managing Employee |
May 8, 2025 | ||
| Monya York |
Corporate Director |
May 8, 2025 | |
| W-2 Managing Employee | May 8, 2025 | ||
| Operational/Managerial Control | Jul 10, 2017 | ||
| Randi L Davis |
Corporate Director |
May 18, 2026 | |
| W-2 Managing Employee |
May 8, 2025 | ||
| Operational/Managerial Control |
May 18, 2026 | ||
| Kasey Crawford |
Corporate Director |
May 18, 2026 | |
| W-2 Managing Employee |
May 18, 2026 | ||
| Operational/Managerial Control |
May 18, 2026 |
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Access Medical Clinic Arkansas LTC LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
| Access Medical Clinic Arkansas LTC LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
| Access Medical Clinic Arkansas LTC LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
| Access Medical Clinic Arkansas LTC LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
| Access Medical Clinic Arkansas LTC LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
| Access Medical Clinic Arkansas LTC LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
| Access Medical Clinic Arkansas LTC LLC |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
| Access Medical Clinic Arkansas |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jul 24, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170124001288 | AR | Part B Supplier - Clinic/Group Practice | 5890077093 |
Receives reassigned benefits from 171 practitioners 43 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Heber Springs, AR; Hope, AR; Lamar, AR; Mena, AR; Mountain Home, AR; Newport, AR; Osceola, AR; Ozark, AR… |
| O20200720001422 | AR | Part a Provider - Rural Health Clinic | 5890077093 | Practice locations: Viola, AR |
National Provider Directory
- Tax ID family
- Access Medical Clinic Arkansas LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
9798 Highway 62 W
Viola, AR 72583-6001
Mailing address
4196 Highway 62 412 Ste a
Hardy, AR 72542-8002
Other providers in Viola, AR
All providers in Viola, AR · Rural Health Clinic/Center in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2020. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.