NPIMap

Organization Active NPI

Mainline Health Systems, Inc

Doing business as Warren High School BH

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
National Provider Identifier
1942929732
Registry record updated Mar 20, 2026
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
Warren High School BH
Practice address
931 N Myrtle St
Building D
Warren, AR 71671-2028
Phone
(870) 226-6754
Fax
(870) 226-7925
NPI assigned
Aug 24, 2022
Last updated
Mar 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2026

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

931 N Myrtle St
Building D
Warren, AR 71671-2028

Mailing address

342 Highway 425 S
Monticello, AR 71655-4612
Phone (870) 942-3000

Other identifiers 1

IdentifierTypeStateIssuer
300240749MedicaidAR

Other names 1

  • Warren High School BH Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20230126000641 AR Part A Provider - Federally Qualified Health Center (FQHC) 5193785590 Practice locations: Warren, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942929732. Details of each certification follow.

Federally qualified health center certification: CCN 041019

Legal name
MAINLINE HEALTH SYSTEMS INC
Doing business as
WARREN HIGH SCHOOL BH (SEABEC)
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2023
Last certification
Jan 24, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1978 in AR
Enrollment address
931 N Myrtle St
Building D
Warren, AR 71671-2028

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gary Nichols Individual W-2 Managing EmployeeCeo Aug 15, 2022
Operational/Managerial ControlCeo Aug 15, 2022
Ron Miller Individual Corporate OfficerBoard Member VP Aug 15, 2022
Robert Thomas Individual Corporate OfficerBoard Member Aug 15, 2022
Brandi Poole Individual Corporate OfficerBoard Member Aug 15, 2022
Alicia Whitaker Individual Corporate OfficerBoard Member President Aug 15, 2022
Mainline Health Systems Inc Organization, Dermott, AR Non-profit Operational/Managerial Control Aug 15, 2022
Mary Hollins Scott Individual Corporate OfficerBoard Member Aug 15, 2022
Keith Shepherd Individual Corporate OfficerBoard Member Aug 15, 2022
Eugene Butler Individual Corporate OfficerBoard Member Aug 15, 2022
Becky Philips Individual Corporate OfficerBoard Member Treasurer Aug 15, 2022
Elyse Knobloch Individual Operational/Managerial ControlChief Financial Officer Aug 14, 2023
Michelle Dunbar Individual Corporate OfficerBoard Member Aug 15, 2022
Shanna Knowles Individual Corporate OfficerBoard Member Aug 15, 2022

All facility ownership & control disclosures 25

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Monticello Community Health CenterMonticello, AR, CCN 041875 Federally qualified health center Operational/Managerial Control Jul 1, 2010
Portland Elementary ClinicPortland, AR, CCN 041917 Federally qualified health center Operational/Managerial Control (100%) Jan 11, 2016
Hamburg ElementartyHamburg, AR, CCN 041918 Federally qualified health center Operational/Managerial Control (100%) Jan 11, 2016
Mainline Health Systems IncHamburg, AR, CCN 041919 Federally qualified health center Operational/Managerial Control (100%) Jan 11, 2016
Star City Community Health CenterStar City, AR, CCN 041921 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2013
Dermott School ClinicDermott, AR, CCN 041922 Federally qualified health center Operational/Managerial Control (100%) Aug 17, 2016
Star City High School ClinicStar City, AR, CCN 041923 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2017
Jimmy Brown ElementaryStar City, AR, CCN 041926 Federally qualified health center Operational/Managerial Control (100%) Apr 4, 2017
Eudora Elementary ClinicEudora, AR, CCN 041933 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2017
Drew Central SchoolMonticello, AR, CCN 041935 Federally qualified health center Operational/Managerial Control (100%) Aug 14, 2017
Lakeside SchoolLake Village, AR, CCN 041934 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2017
Hamburg Middle SchoolHamburg, AR, CCN 041945 Federally qualified health center Operational/Managerial Control (100%) Sep 20, 2018
Mainline Health Systems IncRison, AR, CCN 041953 Federally qualified health center Operational/Managerial Control (100%) Dec 26, 2018
Warren 2Warren, AR, CCN 041966 Federally qualified health center Operational/Managerial Control (100%) Jan 2, 2020
Mainline Health Systems IncMonticello, AR, CCN 041005 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 ClinicMonticello, AR, CCN 041006 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 SchoolSheridan, AR, CCN 041008 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 ClinicSheridan, AR, CCN 041009 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 BHWarren, AR, CCN 041013 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
Mainline Health Systems IncWarren, AR, CCN 041025 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 15, 2022
Aug 15, 2022
Brunson Elementary SchoolWarren, AR, CCN 041015 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 EndLittle Rock, AR, CCN 041023 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Aug 15, 2022
Aug 15, 2022
Warren ElementaryWarren, AR, CCN 041033 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 26, 2023
Jun 26, 2023
Lake Village OB ClinicLake Village, AR, CCN 041047 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 CenterRison, AR, CCN 041084 Federally qualified health center Operational/Managerial Control (100%) Aug 14, 2017

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 25

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773964800000",
    "number": "1942929732",
    "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": "931 N MYRTLE ST",
            "address_2": "BUILDING D",
            "city": "WARREN",
            "state": "AR",
            "postal_code": "716712028",
            "telephone_number": "870-226-6754",
            "fax_number": "870-226-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-24",
        "last_updated": "2026-03-20",
        "certification_date": "2026-03-20",
        "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": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300240749",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warren High School BH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Warren, AR

Sources for this page

Verify at the official NPI Registry.