Healthcare Provider Details

I. General information

NPI: 1114974615
Provider Name (Legal Business Name): JPC MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W. COURT ST.
PARAGOULD AR
72450-4247
US

IV. Provider business mailing address

1300 W. COURT ST.
PARAGOULD AR
72450-4247
US

V. Phone/Fax

Practice location:
  • Phone: 870-236-4100
  • Fax: 870-236-4122
Mailing address:
  • Phone: 870-236-4100
  • Fax: 870-236-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3472
License Number StateAR

VIII. Authorized Official

Name: DR. JOHN RAYMOND HINES
Title or Position: CEO
Credential: D.O.
Phone: 870-236-4100