Provider Demographics
NPI:1073748406
Name:JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:JOHN ED CHAMBERS MEMORIAL HOSPITAL, INC.
Other - Org Name:CHAMBERS MEMORIAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:MICHAELLE
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-495-2241
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72833-0639
Mailing Address - Country:US
Mailing Address - Phone:479-495-2241
Mailing Address - Fax:479-495-6290
Practice Address - Street 1:719 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:AR
Practice Address - Zip Code:72833-9607
Practice Address - Country:US
Practice Address - Phone:479-495-2241
Practice Address - Fax:479-495-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
ARAR4293261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR113073002Medicaid
AR195803002Medicaid