Healthcare Provider Details

I. General information

NPI: 1275558710
Provider Name (Legal Business Name): JOHNSON REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICINE DR
CLARKSVILLE AR
72830-4431
US

IV. Provider business mailing address

PO BOX 440
CLARKSVILLE AR
72830-0440
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-6510
  • Fax: 479-754-5644
Mailing address:
  • Phone: 479-754-6510
  • Fax: 479-754-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. ROBERT LARRY MORSE
Title or Position: ADMINISTRATOR
Credential:
Phone: 479-754-5454