Mainline Health Systems, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Monticello, AR
NPI 1669401501 · NPPES record last updated Mar 20, 2026
Key facts
- NPI
- 1669401501
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MAINLINE HEALTH SYSTEMS, INC
- Practice address
- 342 Highway 425 S
Monticello, AR 71655-4612 - Phone
- (870) 942-3000
- Fax
- (870) 942-3005
- NPI assigned
- Jul 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Gary Allan Nichols
- Title
- Ceo
- Phone
- (870) 942-3000
Other NPIs on the same Medicare enrollment 11
Practitioners 39
-
Meredith B Allison, ANP
-
Jesse Bone, CNP
-
Debbie Clark, LPC
-
Kristen Dent, M.D.
-
Terri Ann Eubanks, DDS
-
Myra Brooke Flemister, APRN
-
Angela D Haynes, FNP-C
-
Annie Marie Haynes, LCSW
-
Brittney Hensley, CNP
-
Laura Susan Hensley, APRN
-
Jasmine Jackson, NP
-
Scott Allison Johnson, LCSW
-
April Summer McGhee, APRN
-
Byron K Montgomery, ANP
-
Kathryn Pippin, APRN
-
Wendy Michelle Ray, PMHNP
-
Heath A Reep, ANP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Federally qualified health center certification: CCN 041805
- Legal name
- MAINLINE HEALTH SYSTEMS INC
- Doing business as
- PORTLAND HEALTH CARE CENTER
- 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
- Enrollment address
- 233 N Main St
Portland, AR 71663-9230
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Gary Nichols |
Corporate Director |
Sep 8, 2008 | |
| W-2 Managing Employee |
Sep 8, 2008 | ||
| Ron Miller |
Corporate Director |
Feb 15, 2011 | |
| Robert Thomas |
Corporate Director |
Feb 15, 2011 | |
| Brandi Poole |
Corporate Director |
Jan 1, 2019 | |
| Alicia Whitaker |
Corporate Director |
Sep 1, 2018 | |
| Mary Hollins Scott |
Corporate Director |
Feb 15, 2011 | |
| Keith Shepherd |
Corporate Director |
Jan 1, 2018 | |
| Eugene Butler |
Corporate Director |
Jan 1, 2016 | |
| Becky Philips |
Corporate Officer |
Jan 1, 2019 | |
| Elyse Knobloch |
Corporate Officer |
Aug 14, 2023 | |
| Michelle Dunbar |
Corporate Director |
Jan 1, 2017 | |
| Shanna Knowles |
Corporate Officer |
Jan 1, 2020 |
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… |
| O20110502000760 | AR | Part a Provider - Federally Qualified Health Center (FQHC) | 5193785590 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Portland, AR |
National Provider Directory
Locations
300 S School St
Dermott, AR 71638
Phone (870) 538-3355
1109 Cub Dr
Hamburg, AR 71646
Phone (870) 224-0116
512 W Church St
Sheridan, AR 72150
400 E Arkansas St
Star City, AR 71667
Phone (866) 446-3647
400 E Arkansas St
Rm 3
Star City, AR 71667
408 N Bradley St
Warren, AR 71671
Phone (870) 226-6786
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
342 Highway 425 S
Monticello, AR 71655-4612
Mailing address
342 Highway 425 S
Monticello, AR 71655-4612
Phone (870) 942-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122649741 | Medicaid | AR |
Other providers in Monticello, AR
- Main Street Family Dental
- Mainline Health Systems Inc
- Mainline Health Systems Inc
- Mainline Health Systems Inc
- Mainline Health Systems, Inc
- Mainline Health Systems, Inc
- Mainline Health Systems, Inc
- Mainline Pharmacy Services Inc
- Mainline Pharmacy Services Inc
- Tolmeia Maize
All providers in Monticello, 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 20, 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.