Healthcare Provider Details

I. General information

NPI: 1073908521
Provider Name (Legal Business Name): CABUN RURAL HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LEE STREET
HAMPTON AR
71744-1196
US

IV. Provider business mailing address

402 LEE STREET
HAMPTON AR
71744-1196
US

V. Phone/Fax

Practice location:
  • Phone: 870-798-4064
  • Fax: 870-798-4100
Mailing address:
  • Phone: 870-798-4064
  • Fax: 870-798-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2215
License Number StateAR

VIII. Authorized Official

Name: MELANIE J SHEPPARD
Title or Position: CEO
Credential: RN
Phone: 870-798-4064