Basic Information
| Provider Information | |||||||||
| NPI: | 1588654982 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH ARKANSAS REGIONAL MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEWTON COUNTY FAMILY PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 445 | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726410445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704462203 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 502 W COURT ST | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8704462203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PANNELL | ||||||||
| AuthorizedOfficialFirstName: | KEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCIAL SERVICES/CFO | ||||||||
| AuthorizedOfficialTelephone: | 8704145157 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | AR3203 | AR | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 5B499 | 01 | AR | BLUE CROSS BLUE SHIELD | OTHER | 131314729 | 05 | AR | MEDICAID |