Healthcare Provider Details

I. General information

NPI: 1912946807
Provider Name (Legal Business Name): CABUN RURAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LEE ST
HAMPTON AR
71744-8937
US

IV. Provider business mailing address

PO BOX 851
HAMPTON AR
71744-0851
US

V. Phone/Fax

Practice location:
  • Phone: 870-798-4299
  • Fax: 870-798-4100
Mailing address:
  • Phone: 870-798-4299
  • Fax: 870-798-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DIANE JOHNSTON
Title or Position: BILLING SUPERVISOR
Credential: LPN LRT RMC
Phone: 870-798-3515