Provider Demographics
NPI:1336587559
Name:MKJD, LLC
Entity Type:Organization
Organization Name:MKJD, LLC
Other - Org Name:STARS ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-3200
Mailing Address - Street 1:200 GENERAL ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-9407
Mailing Address - Country:US
Mailing Address - Phone:870-793-3200
Mailing Address - Fax:870-793-3208
Practice Address - Street 1:200 GENERAL ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9407
Practice Address - Country:US
Practice Address - Phone:870-793-3200
Practice Address - Fax:870-793-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty