Mainline Health Systems, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Eudora, AR
NPI 1619082724 · NPPES record last updated Mar 23, 2026
Key facts
- NPI
- 1619082724
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MAINLINE HEALTH SYSTEMS, INC
- Practice address
- 579 E Beouff St
Eudora, AR 71640-3090 - Phone
- (870) 355-2512
- Fax
- (855) 754-0598
- NPI assigned
- Aug 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Gary Allan Nichols
- Title
- Ceo
- Phone
- (870) 942-3000
Corporate family (same tax ID) 33
Practitioners 3
-
Annie Marie Haynes, LCSW
-
Kathryn Pippin, APRN
-
Robert F Wawrzynek Jr., PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D0465375 | Mainline Health Systems Eudora | Accreditation | Jun 2, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
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
- Corporation · Non-profit
- Incorporated
- Feb 2, 1987 in AR
- Enrollment address
- 579 E Beouff St
Eudora, AR 71640-3090
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Gary Nichols |
W-2 Managing Employee |
Sep 8, 2008 | |
| Operational/Managerial Control |
Sep 8, 2008 | ||
| Ron Miller |
Corporate Director |
Apr 18, 2011 | |
| Robert Thomas |
Corporate Director |
Apr 18, 2011 | |
| Brandi Poole |
Corporate Officer |
Jan 1, 2018 | |
| Alicia Whitaker |
Corporate Officer |
Jan 1, 2018 | |
| Mary Hollins Scott |
Corporate Director |
Apr 18, 2011 | |
| 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 | |
| Operational/Managerial Control |
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 |
|---|---|---|---|---|
| O20110503000329 | AR | Part a Provider - Federally Qualified Health Center (FQHC) | 5193785590 | Practice locations: Eudora, AR |
National Provider Directory
- Tax ID family
- Sanyasi R Ganta MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist |
103TB0200X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
579 E Beouff St
Eudora, AR 71640-3090
Mailing address
342 Highway 425 S
Monticello, AR 71655-4612
Phone (870) 942-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122646749 | Medicaid | AR |
Other names
- EUDORA MEDICAL CLINIC
Other providers in Eudora, AR
- Eudora Pharmacy Inc
- Eudora Pharmacy Inc
- Cassidy Jo L Gavin Sanders
- Genesis Medical Center
- Ruby J. Lee
- Mainline Health Systems, Inc
- Vunkisha Nash
- Janet L Nelson
- Perchel Labs
- Perchel Labs, LLC
All providers in Eudora, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.