Provider Demographics
NPI:1568471571
Name:ARKANSAS RURAL KARE, INC.
Entity Type:Organization
Organization Name:ARKANSAS RURAL KARE, INC.
Other - Org Name:MOUNTAINBURG FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-494-0009
Mailing Address - Street 1:310 TOWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-3831
Mailing Address - Country:US
Mailing Address - Phone:479-494-0009
Mailing Address - Fax:479-494-0005
Practice Address - Street 1:#4 HWY 71 NE
Practice Address - Street 2:
Practice Address - City:MOUNTAINBURG
Practice Address - State:AR
Practice Address - Zip Code:72946
Practice Address - Country:US
Practice Address - Phone:479-369-2091
Practice Address - Fax:479-369-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR770245002OtherARKANSAS BREASTCARE
AR043857Medicare ID - Type Unspecified
AR770245002OtherARKANSAS BREASTCARE