NPIMap

Organization Active NPI

Little River Medical Center, Inc.

Doing business as Memorial Medical Clinic

  • Family Medicine Physician
  • Ashdown, AR
National Provider Identifier
1962719856
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LITTLE RIVER MEDICAL CENTER, INC.
Doing business as
Memorial Medical Clinic
Practice address
370 W Main St
Ashdown, AR 71822-2750
Phone
(870) 898-4100
Fax
(870) 898-5791
NPI assigned
Sep 13, 2010
Last updated
Nov 10, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
LITTLE RIVER MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Vicki Ann Keener
Title
Adm. Assistant
Phone
(870) 898-5011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

370 W Main St
Ashdown, AR 71822-2750

Mailing address

450 W Locke St
Suite C
Ashdown, AR 71822-3326
Phone (870) 898-5011

Other identifiers 2

IdentifierTypeStateIssuer
5G384OtherARBCS
191446002MedicaidAR

Other names 1

  • Memorial Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200909002728 AR Part B Supplier - Clinic/Group Practice 5395032999 Receives reassigned benefits from 1 practitioner
Practice locations: Ashdown, AR

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2158098Memorial Medical Clinic370 West Main Street, Ashdown, AR 71822Certificate of waiverNov 19, 2026

National Provider Directory

National Provider Directory
Tax ID family
Little River Medical Center3 organizations share this tax ID, including this one
Part of
Little River Medical Center

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

370 W Main St
Ashdown, AR 71822
Phone (870) 898-4100

502 E 3rd Ave
Foreman, AR 71836
Phone (870) 600-9549

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": "1284336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1962719856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 W LOCKE ST",
            "address_2": "SUITE C",
            "city": "ASHDOWN",
            "state": "AR",
            "postal_code": "718223326",
            "telephone_number": "870-898-5011",
            "fax_number": "870-898-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 W MAIN ST",
            "city": "ASHDOWN",
            "state": "AR",
            "postal_code": "718222750",
            "telephone_number": "870-898-4100",
            "fax_number": "870-898-5791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LITTLE RIVER MEDICAL CENTER, INC.",
        "enumeration_date": "2010-09-13",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "KEENER",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADM. ASSISTANT",
        "authorized_official_telephone_number": "870-898-5011",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCS",
            "identifier": "5G384",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191446002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashdown, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.