Provider Demographics
NPI:1922789676
Name:NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC
Other - Org Name:NEA BAPTIST URGENT CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP/CLO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-227-5233
Mailing Address - Street 1:350 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2177
Mailing Address - Country:US
Mailing Address - Phone:901-227-5233
Mailing Address - Fax:
Practice Address - Street 1:3001 APACHE DR STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7447
Practice Address - Country:US
Practice Address - Phone:870-936-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-26
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care