Provider Demographics
NPI:1033247176
Name:MCGEHEE DESHA CO HOSPITAL
Entity Type:Organization
Organization Name:MCGEHEE DESHA CO HOSPITAL
Other - Org Name:MAIN STREET MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:KONG
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-222-3644
Mailing Address - Street 1:206 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MCGEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-2339
Mailing Address - Country:US
Mailing Address - Phone:870-222-3644
Mailing Address - Fax:870-222-3682
Practice Address - Street 1:206 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MCGEHEE
Practice Address - State:AR
Practice Address - Zip Code:71654-2339
Practice Address - Country:US
Practice Address - Phone:870-222-3644
Practice Address - Fax:870-222-3682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3053305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization