Provider Demographics
NPI:1821032046
Name:CABUN RURAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:CABUN RURAL HEALTH SERVICES, INC
Other - Org Name:STRONG CLINIC
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:870-798-4064
Mailing Address - Street 1:PO BOX 565
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:AR
Mailing Address - Zip Code:71765-0565
Mailing Address - Country:US
Mailing Address - Phone:870-797-7620
Mailing Address - Fax:870-797-2459
Practice Address - Street 1:253 S CONCORD
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:AR
Practice Address - Zip Code:71765
Practice Address - Country:US
Practice Address - Phone:870-797-7620
Practice Address - Fax:870-797-2459
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:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122633749Medicaid
041827Medicare Oscar/Certification
AR57077Medicare PIN