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General NPI Number Information
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NPI Number | 1346661956
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Entity Type | Organization
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Legal Business Name | NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 4802 E. JOHNSON AVENUE
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City | JONESBORO
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State | AR
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Zip | 72401
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Country | US
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Telephone | 870-936-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 350 N HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2177
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SR. VP / CORPORATE SECRETARY
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Name | MR. GREGORY M. DUCKETT
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Credential |
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Telephone | 901-227-5233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | MC-2122
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License Number State | AR
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