Provider Demographics
NPI:1295952182
Name:EAST ARKANSAS FAMILY HEALTH CENTER INC.
Entity type:Organization
Organization Name:EAST ARKANSAS FAMILY HEALTH CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARD-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-735-3842
Mailing Address - Street 1:102 W BROAD
Mailing Address - Street 2:
Mailing Address - City:LEPANTO
Mailing Address - State:AR
Mailing Address - Zip Code:72354
Mailing Address - Country:US
Mailing Address - Phone:870-735-3846
Mailing Address - Fax:870-732-1940
Practice Address - Street 1:102 W BROAD
Practice Address - Street 2:
Practice Address - City:LEPANTO
Practice Address - State:AR
Practice Address - Zip Code:72354
Practice Address - Country:US
Practice Address - Phone:870-735-3846
Practice Address - Fax:870-732-1940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST ARKANSAS FAMILY HEALTH CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-20
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100862407Medicaid