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General NPI Number Information
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NPI Number | 1114974615
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Entity Type | Organization
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Legal Business Name | JPC MEDICAL INC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 1300 W. COURT ST.
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City | PARAGOULD
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State | AR
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Zip | 72450-4247
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Country | US
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Telephone | 870-236-4100
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Fax | 870-236-4122
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Provider Business Mailing Address
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Address Line | 1300 W. COURT ST.
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City | PARAGOULD
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State | AR
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Zip | 72450-4247
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Country | US
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Telephone | 870-236-4100
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Fax | 870-236-4122
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN RAYMOND HINES
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Credential | D.O.
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Telephone | 870-236-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E3472
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License Number State | AR
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