Healthcare Provider Details

I. General information

NPI: 1083797468
Provider Name (Legal Business Name): JOANN C HAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W C PL
RUSSELLVILLE AR
72801-2773
US

IV. Provider business mailing address

PO BOX 1193
RUSSELLVILLE AR
72811-1193
US

V. Phone/Fax

Practice location:
  • Phone: 479-967-6494
  • Fax: 479-967-6494
Mailing address:
  • Phone: 479-967-6494
  • Fax: 479-967-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name: JOANN C HAYS
Title or Position: OWNER
Credential:
Phone: 479-967-6494