Provider Demographics
NPI:1811435894
Name:NORTH METRO MEDICAL
Entity type:Organization
Organization Name:NORTH METRO MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAHLIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:501-985-7000
Mailing Address - Street 1:1432 BRADEN STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72018
Mailing Address - Country:US
Mailing Address - Phone:501-985-7000
Mailing Address - Fax:
Practice Address - Street 1:1432 BRADEN STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72018
Practice Address - Country:US
Practice Address - Phone:501-985-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004973273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit