NPIMap

Organization Active NPI

Cabun Rural Health Services, Inc

Doing business as Wildcat Wellness Center

  • Federally Qualified Health Center (FQHC)
  • El Dorado, AR
National Provider Identifier
1104583962
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CABUN RURAL HEALTH SERVICES, INC
Doing business as
Wildcat Wellness Center
Practice address
601 Dr. MLK Jr. Blvd
El Dorado, AR 71730
Phone
(870) 639-3875
Fax
(870) 798-4100
NPI assigned
Nov 29, 2021
Last updated
Nov 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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

Authorized official

Name
Susan D Johnston
Title
Cio
Phone
(870) 798-4064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

601 Dr. MLK Jr. Blvd
El Dorado, AR 71730

Mailing address

601 Dr. MLK Jr. Blvd
El Dorado, AR 71730-0601
Phone (870) 639-3875

Other names 1

  • Wildcat Wellness Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL cabunchc@cabun.org

National Provider Directory

National Provider Directory
Tax ID family
Cabun Rural HLT Serv St9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638144000000",
    "number": "1104583962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 DR. MLK JR. BLVD",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717300601",
            "telephone_number": "870-639-3875",
            "fax_number": "870-798-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 DR. MLK JR. BLVD",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "71730",
            "telephone_number": "870-639-3875",
            "fax_number": "870-798-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CABUN RURAL HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-29",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSTON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CIO",
        "authorized_official_telephone_number": "870-798-4064"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "cabunchc@cabun.org",
            "affiliation": "N",
            "address_1": "601 Dr. MLK Jr. Blvd",
            "city": "El Dorado",
            "state": "AR",
            "country_code": "US",
            "postal_code": "71730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wildcat Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Dorado, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.