Healthcare Provider Details

I. General information

NPI: 1023376589
Provider Name (Legal Business Name): DEQUEEN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 W COLLIN DR.
DEQUEEN AR
71832
US

IV. Provider business mailing address

1306 W COLLIN DR.
DEQUEEN AR
71832
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License NumberPTA 2475
License Number StateAR

VIII. Authorized Official

Name: MELANIE COPLEN
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 870-451-1132