Provider Demographics
NPI:1942439120
Name:AMMC PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:AMMC PHYSICIAN SERVICES, INC
Other - Org Name:PARAGOULD CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-239-7000
Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 9
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8450
Mailing Address - Fax:870-239-8454
Practice Address - Street 1:1000 W KINGSHIGHWAY STE 9
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4197
Practice Address - Country:US
Practice Address - Phone:870-239-8450
Practice Address - Fax:870-239-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3227207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty