Basic Information
| Provider Information | |||||||||
| NPI: | 1780667618 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR HAYES YOUNG & JACOBS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 FALLS BLVD S | ||||||||
| Address2: | |||||||||
| City: | WYNNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723963501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702383261 | ||||||||
| FaxNumber: | 8702383115 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 FALLS BLVD S | ||||||||
| Address2: | |||||||||
| City: | WYNNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723963501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702383261 | ||||||||
| FaxNumber: | 8702383115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | JACOBS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | ROBINSON | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 8702383261 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C4111 | AR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102032001 | 05 | AR | MEDICAID | 0120707 | 01 | AR | UNITED HEALTHCARE | OTHER |