Healthcare Provider Details
I. General information
NPI: 1750488953
Provider Name (Legal Business Name): NORTH CABOT FAMILY MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1911 N 2ND ST
CABOT AR
72023-2209
US
IV. Provider business mailing address
PO BOX 1265
CABOT AR
72023-1265
US
V. Phone/Fax
- Phone: 501-843-5757
- Fax: 501-843-5700
- Phone: 501-843-5757
- Fax: 501-843-5700
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 173000000X |
| Taxonomy | Legal Medicine |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
FLOYD
A
SHURLEY
JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 501-843-5757