Healthcare Provider Details

I. General information

NPI: 1386865442
Provider Name (Legal Business Name): FERGUSON HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S MAIN ST
NASHVILLE AR
71852-2406
US

IV. Provider business mailing address

PO BOX 522
NASHVILLE AR
71852-0522
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-0033
  • Fax:
Mailing address:
  • Phone: 870-845-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberC8428
License Number StateAR

VIII. Authorized Official

Name: DR. CLAY WALT FERGUSON
Title or Position: PRESIDENT
Credential: MD
Phone: 870-845-0033