Organization
LEE COUNTY COOPERATIVE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS OSSIE M HALL (CASHIER/BILLING SUPERVISOR)
(870) 295-5225
Entity
Organization
Contact information
Practice address
530 WEST ATKINS BLVD, MARIANNA, AR 72360-2113
(870) 295-5225
(870) 295-6900
Mailing address
PO BOX 669, MARIANNA, AR 72360-0669
(870) 295-5225
(870) 295-6900
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117597749
—
AR
01
—
5G122
MEDICARE GROUP PTAN
AR
Enumeration date
08/04/2006
Last updated
09/21/2021
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