=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275558710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHNSON REGIONAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 MEDICINE DR
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72830-4431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-754-6510
-----------------------------------------------------
Fax | 479-754-5644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 440
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72830-0440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-754-6510
-----------------------------------------------------
Fax | 479-754-5644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ROBERT LARRY MORSE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 479-754-5454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------