Healthcare Provider Details

I. General information

NPI: 1821953092
Provider Name (Legal Business Name): CHICOT MEMORIAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 LOUIS SESSIONS ST
LAKE VILLAGE AR
71653-6049
US

IV. Provider business mailing address

2729 S HIGHWAY 65 82
LAKE VILLAGE AR
71653-6136
US

V. Phone/Fax

Practice location:
  • Phone: 870-265-9200
  • Fax: 870-265-2091
Mailing address:
  • Phone: 870-265-9200
  • Fax: 870-265-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN E HEARD
Title or Position: CEO
Credential:
Phone: 870-265-9332