Healthcare Provider Details

I. General information

NPI: 1851657415
Provider Name (Legal Business Name): DEQUEEN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 W COLLIN RAYE DR
DE QUEEN AR
71832-2502
US

IV. Provider business mailing address

1306 W COLLIN RAYE DR
DE QUEEN AR
71832-2502
US

V. Phone/Fax

Practice location:
  • Phone: 870-642-4990
  • Fax: 870-642-7250
Mailing address:
  • Phone: 870-642-4990
  • Fax: 870-642-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number1184612194
License Number StateAR

VIII. Authorized Official

Name: DR. MELANIE RENEE COPLEN
Title or Position: DIRECTOR OF THERAPY
Credential: PHYSICAL THERAPIST
Phone: 870-642-4990