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General NPI Number Information
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NPI Number | 1417721689
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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 | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 4800 E JOHNSON AVE
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City | JONESBORO
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State | AR
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Zip | 72405-8413
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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 | 901-227-5233
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Fax |
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Authorized Official
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Title or Position | SR VP/CHIEF LEGAL OFFICER
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Name | MR. GREGORY M DUCKETT
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Credential | SR. VP/CLO
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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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0207X
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Taxonomy Name | Mobile Mammography Clinic/Center
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License Number |
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License Number State |
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