CADDO RIVER MEDICAL CLINIC PLLC
NPI 1194644575
Clinic/Center in Glenwood, AR
About Caddo River Medical Clinic Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CADDO RIVER MEDICAL CLINIC PLLC (NPI 1194644575) is a healthcare organization registered as a clinic/center in Glenwood, Arkansas and active in the NPI registry since July 2026. The organization holds a CLIA Waiver certificate valid through August 4, 2028 and lists Rickey Edna Mack, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Caddo River Medical Clinic Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Caddo River Medical Clinic PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 04D2348347
Caddo River Medical Clinic PLLC · Glenwood, ARFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Caddo River Medical Clinic PLLC's NPI number?
The NPI number for Caddo River Medical Clinic PLLC is 1194644575. It was assigned to this organization in the NPPES registry on July 10, 2026.
Where is Caddo River Medical Clinic PLLC located?
Caddo River Medical Clinic PLLC is located at 180 Highway 70 E Ste 11, Glenwood, AR 71943. The listed phone number is (870) 669-9840.
What is Caddo River Medical Clinic PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Caddo River Medical Clinic PLLC enrolled in Medicare?
Yes. Caddo River Medical Clinic PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Caddo River Medical Clinic PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Caddo River Medical Clinic PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Caddo River Medical Clinic PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 04D2348347) is associated with this NPI, valid through August 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Caddo River Medical Clinic PLLC was last updated on September 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 33 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Caddo River Medical Clinic Pllc · NPI 1194644575
Clinic/Center organization in Glenwood, Arkansas. Organization record, active in the CMS NPPES registry since July 10, 2026.
## Identity
- **NPI:** 1194644575 (Entity type: Organization)
- **Enumerated:** July 10, 2026
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Rickey Mack, OWNER
## Practice location
- **Address:** 180 HIGHWAY 70 E STE 11, Glenwood, AR 71943-8810
- **Phone:** (870) 669-9840
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 22, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1194644575) · Data from the CMS NPPES public registry.