Healthcare Provider Details

I. General information

NPI: 1629017405
Provider Name (Legal Business Name): CABUN RURAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N HILL ST
AMITY AR
71921-9635
US

IV. Provider business mailing address

PO BOX 218
AMITY AR
71921-0218
US

V. Phone/Fax

Practice location:
  • Phone: 870-342-5006
  • Fax: 870-342-5802
Mailing address:
  • Phone: 870-342-5006
  • Fax: 870-342-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DIANE JOHNSTON
Title or Position: BILLING SUPERVISOR
Credential: LPN, LRT, RMC
Phone: 870-798-3515