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General NPI Number Information
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NPI Number | 1063717106
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Entity Type | Organization
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Legal Business Name | JACKIE CHEATHAM
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 907 AR HWY 56
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City | CALICO ROCK
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State | AR
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Zip | 72519
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Country | US
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Telephone | 870-291-1898
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Fax |
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Provider Business Mailing Address
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Address Line | 907 AR HWY 56 PO BOX 261
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City | CALICO ROCK
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State | AR
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Zip | 72519
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Country | US
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Telephone | 870-291-1898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACKIE CHEATHAM
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Credential |
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Telephone | 870-291-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333300000X
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Taxonomy Name | Emergency Response System Companies
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License Number | 204
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License Number State | AR
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