Mainline Health Systems Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Dermott, AR
NPI 1386758043 · NPPES record last updated Mar 23, 2026
Key facts
- NPI
- 1386758043
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MAINLINE HEALTH SYSTEMS INC
- Practice address
- 300 S School St
Dermott, AR 71638-2127 - Phone
- (870) 538-5296
- Fax
- (855) 811-4203
- NPI assigned
- Aug 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Gary Allan Nichols
- Title
- Ceo
- Phone
- (870) 942-3000
Other NPIs on the same Medicare enrollment 10
Practitioners 15
-
Rebekah Ayecock, PMHNP
-
Jennifer Cotton, CASE MANAGER
-
Kimberly Kay Golden, M.D.
-
Jaime B Harvey, MS, LAC
-
Mollye Jenay Koonce, APRN, FNP-C
-
Kendal Noble, APRN
-
Dana Shea Phillips, FNP-BC
-
Karen J. Richardson, APN
-
Holley Shelton, APN-NP
-
Kelly Dean Shrum, DO
-
Kimberly Weeks, CNP
-
Leah Jacks Williams, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Federally qualified health center certification: CCN 041809
- Legal name
- MAINLINE HEALTH SYSTEMS INC
- Doing business as
- MAINLINE DERMOTT MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 1978 in AR
- Enrollment address
- 300 S School St
Dermott, AR 71638-2127
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Gary Nichols |
Corporate Director |
Sep 8, 2008 | |
| Ron Miller |
Corporate Director |
Apr 18, 2011 | |
| Robert Thomas |
Corporate Director |
Mar 31, 2008 | |
| Brandi Poole |
Corporate Officer |
Jan 1, 2018 | |
| Alicia Whitaker |
Corporate Officer |
Jan 1, 2018 | |
| Mary Hollins Scott |
Corporate Director |
Mar 31, 2008 | |
| Keith Shepherd |
Corporate Director |
Jan 1, 2015 | |
| Eugene Butler |
Corporate Director |
Jan 1, 2012 | |
| Becky Philips |
Corporate Officer |
Jan 1, 2019 | |
| Elyse Knobloch |
Corporate Officer |
Aug 14, 2023 | |
| W-2 Managing Employee |
Aug 14, 2023 | ||
| Michelle Dunbar |
Corporate Director |
Jan 1, 2012 | |
| Shanna Knowles |
Corporate Officer |
Jan 1, 2020 |
All facility ownership & control disclosures 26
| Facility | Type | Role | Since |
|---|---|---|---|
| Monticello Community Health Center |
Federally qualified health center | Operational/Managerial Control | Jul 1, 2010 |
| Portland Elementary Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 11, 2016 |
| Hamburg Elementarty |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 11, 2016 |
| Mainline Health Systems Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 11, 2016 |
| Star City Community Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 1, 2013 |
| Dermott School Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 17, 2016 |
| Star City High School Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 1, 2017 |
| Jimmy Brown Elementary |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 4, 2017 |
| Eudora Elementary Clinic |
Federally qualified health center | Operational/Managerial Control (100%) | Apr 1, 2017 |
| Drew Central School |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 14, 2017 |
| Lakeside School |
Federally qualified health center | Operational/Managerial Control (100%) | Mar 1, 2017 |
| Hamburg Middle School |
Federally qualified health center | Operational/Managerial Control (100%) | Sep 20, 2018 |
| Mainline Health Systems Inc |
Federally qualified health center | Operational/Managerial Control (100%) | Dec 26, 2018 |
| Warren 2 |
Federally qualified health center | Operational/Managerial Control (100%) | Jan 2, 2020 |
| Mainline Health Systems Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest 5% Or Greater Security Interest Operational/Managerial Control |
Oct 1, 2021 Oct 1, 2021 Oct 1, 2021 |
| Mainline Uam Medical Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest 5% Or Greater Security Interest Operational/Managerial Control |
Oct 1, 2021 Oct 1, 2021 Oct 1, 2021 |
| Sheridan School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest 5% Or Greater Security Interest Operational/Managerial Control |
Apr 1, 2022 Apr 1, 2022 Apr 1, 2022 |
| Sheridan Medical Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest 5% Or Greater Security Interest Operational/Managerial Control |
Apr 1, 2022 Apr 1, 2022 Apr 1, 2022 |
| Warren Middle School BH |
Federally qualified health center | 5% Or Greater Direct Ownership Interest 5% Or Greater Security Interest Operational/Managerial Control |
Jul 13, 2022 Jul 13, 2022 Jul 13, 2022 |
| Warren High School BH (Seabec) |
Federally qualified health center | Operational/Managerial Control | Aug 15, 2022 |
| Mainline Health Systems Inc |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Aug 15, 2022 Aug 15, 2022 |
| Brunson Elementary School |
Federally qualified health center | 5% Or Greater Direct Ownership Interest 5% Or Greater Security Interest Operational/Managerial Control |
Jul 13, 2022 Jul 13, 2022 Jul 13, 2022 |
| Sheridan East End |
Federally qualified health center | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Aug 15, 2022 Aug 15, 2022 |
| Warren Elementary |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 26, 2023 Jun 26, 2023 |
| Lake Village OB Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Jul 3, 2023 Jul 3, 2023 |
| Cleveland County School District Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 14, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041011000567 | AR | Part B Supplier - Clinic/Group Practice | 5193785590 |
Receives reassigned benefits from 62 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Portland, AR; Rison, AR; Sheridan, AR; Star City, AR; Star City,, AR; Warren, AR; Wilmot, AR; Eudora, AR… |
| O20080324000149 | AR | Part a Provider - Federally Qualified Health Center (FQHC) | 5193785590 | Practice locations: Dermott, AR |
National Provider Directory
Locations
535 Jordan Dr
Monticello, AR 71655
Phone (870) 367-6246
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist |
103TB0200X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
300 S School St
Dermott, AR 71638-2127
Mailing address
342 Highway 425 S
Monticello, AR 71655-4612
Phone (870) 942-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122645749 | Medicaid | AR |
Other names
- Mainline Dermott Medical Clinic
Other providers in Dermott, AR
- Case Henderson
- Shenika Jackson-King
- Courtney Shay Johnson
- Elmer Ann Johnson
- Courtney Keller
- Mainline Health Systems, Inc
- Mainline Health Systems, Inc
- Mainline Health Systems, Inc
- Marvin D. Loyd, DDS
- Medical Transport Management, Inc
All providers in Dermott, AR · Federally Qualified Health Center (FQHC) in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2026. 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.