Healthcare Provider Details

I. General information

NPI: 1912328428
Provider Name (Legal Business Name): NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 E JOHNSON AVE
JONESBORO AR
72401-8413
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-932-3608
Mailing address:
  • Phone: 870-336-1485
  • Fax: 870-336-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY M. DUCKETT
Title or Position: SR. VP / CORPORATE SECRETARY
Credential:
Phone: 901-227-5233