Provider Demographics
NPI:1952346041
Name:CRITTENDEN CARES, INC
Entity Type:Organization
Organization Name:CRITTENDEN CARES, INC
Other - Org Name:CRITTENDEN PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-735-1500
Mailing Address - Street 1:308 S RHODES ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4215
Mailing Address - Country:US
Mailing Address - Phone:870-732-3353
Mailing Address - Fax:870-732-2662
Practice Address - Street 1:228 W TYLER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4223
Practice Address - Country:US
Practice Address - Phone:870-732-3353
Practice Address - Fax:870-732-2662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRITTENDEN CARES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3036139293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C324OtherBLUE CROSS BLUE SHIELD
AR2692710OtherAETNA
AR5C324OtherBLUE CROSS BLUE SHIELD
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AR=========00OtherQUALCHOICE