Mainline Health Systems, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MAINLINE HEALTH SYSTEMS, INC

Doing business as

Eudora Medical Clinic

Practice address

579 E Beouff St
Eudora, AR 71640-3090

Phone

(870) 355-2512

Fax

(855) 754-0598

NPI assigned

Aug 20, 2006

Last updated

Mar 23, 2026By 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

• EUDORA MEDICAL 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 1619082724. Details of each certification follow.

• CCN 041807 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 041807

Legal name

MAINLINE HEALTH SYSTEMS INC

Doing business as

EUDORA 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

CorporationNon-profit

Incorporated

Feb 2, 1987 in AR

Enrollment address

579 E Beouff St
Eudora, AR 71640-3090

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Sanyasi R Ganta MD36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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 Warren High School Behavioral Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1215700265
  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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

• Mainline Health Systems, Inc

  dba Warren Dental Clinic

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1407510720

  Member Of

  NPD member
• Mainline Health Systems, Inc

  dba Lake Village OB Clinic

  • Federally Qualified Health Center (FQHC)
  • Lake Village, AR
  • NPI 1548949852

  Member Of

  NPD member

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.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Annie Marie Haynes, LCSW

  • Clinical Social Worker
  • Portland, AR
  • NPI 1932336054
  NPD (past)
• Kathryn Pippin, APRN

  • Family Nurse Practitioner
  • Eudora, AR
  • NPI 1780497909
  NPD (past)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774224000000",
    "number": "1619082724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 HIGHWAY 425 S",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554612",
            "telephone_number": "870-942-3000",
            "fax_number": "870-942-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "579 E BEOUFF ST",
            "city": "EUDORA",
            "state": "AR",
            "postal_code": "716403090",
            "telephone_number": "870-355-2512",
            "fax_number": "855-754-0598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "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": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EUDORA MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eudora Pharmacy Inc (Eudora Drug Store)
• Eudora Pharmacy Inc
• Cassidy Jo L Gavin Sanders, APRN
• Genesis Medical Center
• Ruby J. Lee, D.D.S.
• Mainline Health Systems, Inc (Eudora Elementary Clinic)
• Vunkisha Nash, FNP-BC
• Janet L Nelson, M.S.P., CCC-SLP
• Perchel Labs
• Perchel Labs, LLC

• Federally Qualified Health Center (FQHC) in Eudora, AR
• Providers in Eudora, 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 Mar 23, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.