Caddo River Medical Clinic PLLC
NPI 1194644575ActiveOrganization· Clinic/Center· Glenwood, AR
Clinic/Center in Glenwood, Arkansas, registered in NPPES in July 2026. The authorized official on file is Rickey Edna Mack, APRN, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1194644575 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 10, 2026 |
| Last updated in NPPES | Sep 22, 2026 |
| Certified by provider | Sep 22, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center Primary | 261Q00000X | — | — |
| Nurse Practitioner, Family | 363LF0000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (AR) |
|---|
Other Clinic/Center providers in Glenwood
- 1275514838