Organization
MAINLINE HEALTH SYSTEMS, INC.
Active
Other names
Jimmy Brown Dental
Organization subpart
No
Provider details
NPI number
Authorized official
GARY ALLAN NICHOLS (CEO)
(870) 942-3000
Entity
Organization
Contact information
Practice address
310 ASHLEY ST, STAR CITY, AR 71667
(650) 419-2545
(855) 854-6281
Mailing address
342 HIGHWAY 425 S, MONTICELLO, AR 71655-4612
(870) 942-3000
(870) 942-3005
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226030631
—
AR
Enumeration date
03/08/2018
Last updated
03/20/2026
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