Basic Information
| Provider Information | |||||||||
| NPI: | 1952346041 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRITTENDEN CARES, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CRITTENDEN PHYSICIAN SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 308 S RHODES ST | ||||||||
| Address2: | |||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707323353 | ||||||||
| FaxNumber: | 8707322662 | ||||||||
| Practice Location | |||||||||
| Address1: | 228 W TYLER AVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | WEST MEMPHIS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723014223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707323353 | ||||||||
| FaxNumber: | 8707322662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8707351500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CRITTENDEN CARES, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | 3036139 | AR | Y | Laboratories | Physiological Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 5C324 | 01 | AR | BLUE CROSS BLUE SHIELD | OTHER | 2692710 | 01 | AR | AETNA | OTHER |