Provider Demographics
NPI:1689679169
Name:PHYSICIANS NETWORK INC.
Entity Type:Organization
Organization Name:PHYSICIANS NETWORK INC.
Other - Org Name:PNI DBA JACKSONVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CALHOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-985-5900
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-0309
Mailing Address - Country:US
Mailing Address - Phone:501-985-5900
Mailing Address - Fax:501-985-6016
Practice Address - Street 1:1300 BRADEN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3719
Practice Address - Country:US
Practice Address - Phone:501-985-5900
Practice Address - Fax:501-985-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142734002Medicaid
AR4331570001Medicare NSC
AR142734002Medicaid