Healthcare Provider Details

I. General information

NPI: 1699513507
Provider Name (Legal Business Name): SGOH ACQUISITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 N MAIN ST
DECATUR AR
72722-9732
US

IV. Provider business mailing address

346 N MAIN ST
DECATUR AR
72722-9732
US

V. Phone/Fax

Practice location:
  • Phone: 479-752-3233
  • Fax: 479-752-3235
Mailing address:
  • Phone: 479-752-3233
  • Fax: 479-752-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL G TAYLOR
Title or Position: CEO
Credential: JD
Phone: 417-837-4004