Healthcare Provider Details

I. General information

NPI: 1215436613
Provider Name (Legal Business Name): EAST ARKANSAS FAMILY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 US 49
MARVELL AR
72366
US

IV. Provider business mailing address

900 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

V. Phone/Fax

Practice location:
  • Phone: 870-829-1194
  • Fax:
Mailing address:
  • Phone: 870-735-3842
  • Fax: 870-394-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN WARD-JONES
Title or Position: CEO
Credential: MD
Phone: 870-735-3842