NPIMap

Organization Active NPI

Mainline Health Systems, Inc

Doing business as Mainline Dermott Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Dermott, AR
National Provider Identifier
1417064890
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MAINLINE HEALTH SYSTEMS, INC
Doing business as
Mainline Dermott Dental Clinic
Practice address
300 S School St
Dermott, AR 71638-2127
Phone
(870) 538-9720
Fax
(870) 538-9701
NPI assigned
Aug 23, 2006
Last updated
Jul 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

300 S School St
Dermott, AR 71638-2127

Mailing address

PO Box 509
Dermott, AR 71638-0509
Phone (870) 942-3000

Other identifiers 1

IdentifierTypeStateIssuer
152991631MedicaidAR

Other names 1

  • MAINLINE DERMOTT DENTAL CLINIC Doing business as

National Provider Directory

National Provider Directory
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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1417064890",
    "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": "300 S SCHOOL ST",
            "city": "DERMOTT",
            "state": "AR",
            "postal_code": "716382127",
            "telephone_number": "870-538-9720",
            "fax_number": "870-538-9701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "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": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152991631",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAINLINE DERMOTT DENTAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MAINLINE DERMOTT DENTAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dermott, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.