Provider Demographics
NPI:1780738310
Name:JUBAR LLC
Entity type:Organization
Organization Name:JUBAR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-794-1356
Mailing Address - Street 1:201 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4060
Mailing Address - Country:US
Mailing Address - Phone:501-794-1356
Mailing Address - Fax:501-794-1356
Practice Address - Street 1:201 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4060
Practice Address - Country:US
Practice Address - Phone:501-794-1356
Practice Address - Fax:501-794-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165812716Medicaid
AR5967010001Medicare NSC