1922589472 NPI number — JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.

Table of content: SUZANNE NICOLE WARD BCBA (NPI 1780819334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922589472 NPI number — JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
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:
CHAMBERS MEMORIAL EMS
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:
1922589472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 639
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72833-0639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-495-2241
Provider Business Mailing Address Fax Number:
479-495-6299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 DETROIT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72833-9607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-495-2241
Provider Business Practice Location Address Fax Number:
479-495-6299
Provider Enumeration Date:
08/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CORNWELL
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
MICHAELLE
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
479-495-2241

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  AR4825 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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