| NPI | 1861156481 |
|---|---|
| Doing Business As | MAINLINE UAM MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | GARY ALLAN NICHOLS CEO 870-942-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2024-09-18 |