Mena Hospital Commission
Organization Active NPI Family Medicine Physician · Mena, AR
NPI 1003473463 · NPPES record last updated May 21, 2019
Key facts
- NPI
- 1003473463
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MENA HOSPITAL COMMISSION
- Practice address
- 1103 College Dr
Mena, AR 71953-2519 - Phone
- (479) 394-1414
- Fax
- (877) 775-6761
- NPI assigned
- May 21, 2019
- Organization subpart
- No
Authorized official
- Name
- Jay J Quebedeaux
- Title
- Ceo
- Phone
- (479) 243-2237
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 6
Member organizations 5
Practitioners 6
-
Steven P Forrest, M.D.
-
Patrick J. Fox, MD
-
Doris Jean Hastey, PMH-APRN-BC
-
Fayz A Hudefi, MD
-
John D Mesko, M.D.
-
Blake A Little, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040512000557 | AR | Part B Supplier - Clinic/Group Practice | 8527057678 |
Receives reassigned benefits from 15 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mena, AR |
National Provider Directory
- Tax ID family
- Mena Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Pediatrics Physician |
208000000X | |||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
1103 College Dr
Mena, AR 71953-2519
Mailing address
311 Morrow St N
Mena, AR 71953-2516
Phone (479) 243-2130
Other names
- Mena Regional Health System
NPI Registry JSON
{
"created_epoch": "1558396800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1558396800000",
"number": "1003473463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "311 MORROW ST N",
"city": "MENA",
"state": "AR",
"postal_code": "719532516",
"telephone_number": "479-243-2130",
"fax_number": "479-394-4577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1103 COLLEGE DR",
"city": "MENA",
"state": "AR",
"postal_code": "719532519",
"telephone_number": "479-394-1414",
"fax_number": "877-775-6761"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MENA HOSPITAL COMMISSION",
"organizational_subpart": "NO",
"enumeration_date": "2019-05-21",
"last_updated": "2019-05-21",
"status": "A",
"authorized_official_last_name": "QUEBEDEAUX",
"authorized_official_first_name": "JAY",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "479-243-2237"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "General Practice",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Mena Regional Health System",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mena, AR
- Mena Eye Care
- Mena Family Health Center
- Mena General Surgical Services, L.L.C.
- Mena Health, LLC
- Mena Heart and Vascular Clinic
- Mena Hospital Commission
- Mena Hospital Commission
- Mena Hospital Commission
- Mena Hospital Commission
- Mena Hospital Commission
All providers in Mena, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.