Provider Demographics
NPI:1265476402
Name:CABUN RURAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:CABUN RURAL HEALTH SERVICES, INC
Other - Org Name:BEARDEN HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LRT, RMC
Authorized Official - Phone:870-798-3515
Mailing Address - Street 1:150 SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:BEARDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71720
Mailing Address - Country:US
Mailing Address - Phone:870-687-3637
Mailing Address - Fax:870-687-2502
Practice Address - Street 1:150 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:BEARDEN
Practice Address - State:AR
Practice Address - Zip Code:71720
Practice Address - Country:US
Practice Address - Phone:870-687-3637
Practice Address - Fax:870-687-2502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CABUN RURAL HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122638749Medicaid
AR122638749Medicaid
AR57077Medicare PIN