Ark-la-Tex Health Center PC
Organization Active NPI Family Medicine Physician · Texarkana, AR
NPI 1649237165 · NPPES record last updated Oct 1, 2024
Key facts
- NPI
- 1649237165
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- N8393 (AR)
- Legal business name
- ARK-LA-TEX HEALTH CENTER PC
- Practice address
- 1414 Arkansas Blvd
Texarkana, AR 71854-1604 - Phone
- (870) 773-7246
- Fax
- (870) 772-2568
- NPI assigned
- Apr 27, 2006
- Organization subpart
- No
Authorized official
- Name
- James D Raker, DC
- Title
- Ceo
- Phone
- (870) 773-7246
Practitioners 3
-
Matthew Brandon, APRN
-
James D Raker, DC
-
Clayton H Nash, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040217001048 | AR | Part B Supplier - Clinic/Group Practice | 7618862855 |
Receives reassigned benefits from 2 practitioners Practice locations: Texarkana, AR |
National Provider Directory
Locations
1414 Arkansas Blvd
Texarkana, AR 71854
Phone (870) 216-1181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 1141 | AR | |
| Family Medicine Physician |
207Q00000X | N8393 | AR | Yes |
| Acute Care Nurse Practitioner |
363LA2100X | A01334 | AR | |
| Family Nurse Practitioner |
363LF0000X | AO3679 | AR |
Addresses
Primary practice location
1414 Arkansas Blvd
Texarkana, AR 71854-1604
Mailing address
1414 Arkansas Blvd
Texarkana, AR 71854-1604
Phone (870) 773-7246
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 152398002 | Medicaid | AR |
Other names
- Ark-La-Tex Health Center
Other providers in Texarkana, AR
- Anr1-LLC
- Joseph Arman Bongco Aquino
- Arcare
- Rose Archie
- Walter Archie Jr.
- Arkansas CVS Pharmacy L.L.C.
- Arkansas Treatment Services, LLC
- Arkansas Treatment Services, LLC
- Arklatex Family Dental Center
- Arklatex Wound Specialist PLLC
All providers in Texarkana, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.