MEDICARE: CABUN RURAL HEALTH SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629017405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CABUN RURAL HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	AMITY
State	:	AR
Zip	:	71921-0218
Country	:	US
Telephone Number	:	870-342-5006
Fax Number	:	870-342-5802

Provider Business Practice Location Address
First Line	:	329 N HILL ST
Second Line	:
City	:	AMITY
State	:	AR
Zip	:	71921-9635
Country	:	US
Telephone Number	:	870-342-5006
Fax Number	:	870-342-5802

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	SUSAN DIANE JOHNSTON
Credential	:	LPN, LRT, RMC
Telephone Number	:	870-798-3515

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	08/09/2010

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Directions to “CABUN RURAL HEALTH SERVICES, INC ” Practice Location

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