Healthcare Provider Details

I. General information

NPI: 1689679169
Provider Name (Legal Business Name): PHYSICIANS NETWORK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BRADEN ST
JACKSONVILLE AR
72076-3719
US

IV. Provider business mailing address

PO BOX 309
JACKSONVILLE AR
72078-0309
US

V. Phone/Fax

Practice location:
  • Phone: 501-985-5900
  • Fax: 501-985-6016
Mailing address:
  • Phone: 501-985-5900
  • Fax: 501-985-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateAR

VIII. Authorized Official

Name: DR. JULIAN DALE CALHOON
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 501-985-5900