Provider Demographics
NPI:1447571047
Name:MENA FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:MENA FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUEBEDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-394-6100
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-1325
Mailing Address - Country:US
Mailing Address - Phone:479-394-1414
Mailing Address - Fax:870-289-6993
Practice Address - Street 1:1103 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-2519
Practice Address - Country:US
Practice Address - Phone:479-394-1414
Practice Address - Fax:479-243-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty