1174583603 NPI number — JOHNSON REGIONAL MEDICAL CENTER

Table of content: (NPI 1174583603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174583603 NPI number — JOHNSON REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174583603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1836
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72830-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-754-5337
Provider Business Mailing Address Fax Number:
479-754-5348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E POPLAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72830-4419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-754-5337
Provider Business Practice Location Address Fax Number:
479-754-5348
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORSE
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
479-754-2060

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5F191 . This is a "ARK BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com