Provider Demographics
NPI:1275558710
Name:JOHNSON REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:JOHNSON REGIONAL MEDICAL CENTER
Other - Org Name:JOHNSON COUNTY SURGERY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LARRY
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-754-5454
Mailing Address - Street 1:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-0440
Mailing Address - Country:US
Mailing Address - Phone:479-754-6510
Mailing Address - Fax:479-754-5644
Practice Address - Street 1:2 MEDICINE DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4431
Practice Address - Country:US
Practice Address - Phone:479-754-6510
Practice Address - Fax:479-754-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty