Provider Demographics
NPI:1376583757
Name:CABUN RURAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:CABUN RURAL HEALTH SERVICES, INC
Other - Org Name:HOPE MIGRANT COMMUNITY 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:PO BOX 1654
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-1654
Mailing Address - Country:US
Mailing Address - Phone:870-777-8420
Mailing Address - Fax:870-888-2390
Practice Address - Street 1:205 SMITH RD
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8971
Practice Address - Country:US
Practice Address - Phone:870-777-8420
Practice Address - Fax:870-777-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127502749Medicaid
041835Medicare Oscar/Certification
AR127502749Medicaid