MAINLINE HEALTH SYSTEMS INC NPI 1104574219

NPI Information

NPI: 1104574219
Provider Name: MAINLINE HEALTH SYSTEMS INC
Classification: Clinic/Center - 261QF0400X
Specialization: Federally Qualified Health Center (FQHC)
Entity Type: Organization
:
CLIA Number: 04D2233680
Address: 506 LITTLE CREEK CUT OFF RD
SHERIDAN, AR
ZIP 72150
Phone: (870) 942-3000

Map and Directions

Get Directions

NPI Details

MAINLINE HEALTH SYSTEMS INC is a federally qualified health center (fqhc) clinic center in Sheridan, AR. MAINLINE HEALTH SYSTEMS INC NPI is 1104574219. The provider is registered as an organization entity type and is a multi-specialty group.
The provider .

The provider's business location address is:

506 LITTLE CREEK CUT OFF RD
SHERIDAN, AR
ZIP 72150-798
Phone: (870) 942-3000
Fax: (870) 942-3005

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 04D2233680 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/17/2022 and was last updated on 5/15/2025.

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
1	103TB0200X	Psychologist	Cognitive & Behavioral			No
2	261QF0400X	Clinic/Center	Federally 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
1	288140749	MEDICAID	ARKANSAS

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: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI

Next NPI