Organization
DEPARTMENT OF VETERANS AFFAIRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY D. GREATHOUSE L.P.N. (STAFF NURSE)
(870) 216-2512
Entity
Organization
Contact information
Practice address
910 REALTOR AVENUE, TEXARKANA, AR 71854-5066
(870) 824-4181
Mailing address
1107 LOCUST ST, TEXARKANA, AR 71854-5066
(903) 824-4181
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
L29493
AR
Other
Enumeration date
05/01/2008
Last updated
05/01/2008
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