NPIMap

Organization Active NPI

Mena Hospital Commission

Doing business as Mena Regional Health System

  • Family Medicine Physician
  • Mena, AR
National Provider Identifier
1003473463
Registry record updated May 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MENA HOSPITAL COMMISSION
Doing business as
Mena Regional Health System
Practice address
1103 College Dr
Mena, AR 71953-2519
Phone
(479) 394-1414
Fax
(877) 775-6761
NPI assigned
May 21, 2019
Last updated
May 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jay J Quebedeaux
Title
Ceo
Phone
(479) 243-2237

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
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 1

  • Mena Regional Health System Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Mena Medical Center7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.