Healthcare Provider Details

I. General information

NPI: 1598940025
Provider Name (Legal Business Name): CITY OF POCAHONTAS AR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MEDICAL CENTER DR
POCAHONTAS AR
72455-9436
US

IV. Provider business mailing address

2801 MEDICAL CENTER DR
POCAHONTAS AR
72455-9436
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-6000
  • Fax: 870-890-6066
Mailing address:
  • Phone: 870-892-6000
  • Fax: 870-890-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAR4266
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberAR4266
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAR4266
License Number StateAR

VIII. Authorized Official

Name: JOEY E RADCLIFF
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 870-890-6000