Provider Demographics
NPI:1437193646
Name:CABUN RURAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:CABUN RURAL HEALTH SERVICES, INC
Other - Org Name:LEWISVILLE FAMILY PRACTICE 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 1013
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71845-1013
Mailing Address - Country:US
Mailing Address - Phone:870-921-5781
Mailing Address - Fax:870-921-4510
Practice Address - Street 1:1117 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:AR
Practice Address - Zip Code:71845
Practice Address - Country:US
Practice Address - Phone:870-921-5781
Practice Address - Fax:870-921-4510
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
AR122632749Medicaid
AR57077Medicare PIN
041825Medicare Oscar/Certification