MAINLINE HEALTH SYSTEMS INC NPI 1669401501

NPI Information

  • NPI: 1669401501
  • Provider Name: MAINLINE HEALTH SYSTEMS, INC
  • Classification: Clinic/Center - 261QF0400X
  • Specialization: Federally Qualified Health Center (FQHC)
  • Entity Type: Organization
  • CLIA Number: 04D0703375
  • Address: 134 SOUTH STRICKLAND ST
    DERMOTT, AR
    ZIP 71638
  • Phone: (870) 538-5414

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NPI Details

MAINLINE HEALTH SYSTEMS, INC is a federally qualified health center (fqhc) clinic center in Dermott, AR. MAINLINE HEALTH SYSTEMS, INC NPI is 1669401501. The provider is registered as an organization entity type.

The provider's business location address is:

134 SOUTH STRICKLAND ST
DERMOTT, AR
ZIP 71638
Phone: (870) 538-5414
Fax: (870) 538-5412

The provider's authorized official is Gary Allan Nichols .
The authorized official title is Ceo and has the following contact phone number (870) 942-3000.

The CLIA number assigned to this NPI record is 04D0703375 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 7/2/2006 and was last updated on 7/18/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1122649741MEDICAIDARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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