1336198555 NPI number — JOHNSON REGIONAL MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336198555 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:
JRMC PROVIDER BASED PHYSICIANS
Provider Other Organization Name Type Code:
3
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:
1336198555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 738
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:
72830-0738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-754-5454
Provider Business Mailing Address Fax Number:
479-754-5311

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:
479-754-5454
Provider Business Practice Location Address Fax Number:
479-754-5311
Provider Enumeration Date:
05/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORSE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
LARRY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
479-754-5454

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 57977 . This is a "ARKANSAS BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 128372002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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