NPIMap

Organization Active NPI

De Queen Medical Center, Inc

  • Primary Care Clinic/Center
  • De Queen, AR
National Provider Identifier
1124549316
Registry record updated Jun 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
DE QUEEN MEDICAL CENTER, INC
Practice address
1314 W Collin Raye Dr
De Queen, AR 71832-2135
Phone
(870) 642-2273
Fax
(870) 642-2162
NPI assigned
Jun 28, 2017
Last updated
Jun 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2017

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

Authorized official

Name
Mr. Jerramy Icenhower, RN, BSN
Title
Administrator
Phone
(870) 584-0272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

1314 W Collin Raye Dr
De Queen, AR 71832-2135

Mailing address

1306 W Collin Raye Dr
De Queen, AR 71832-2502
Phone (870) 584-4111

National Provider Directory

National Provider Directory
Tax ID family
De Queen Medical Center Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1314 W Collin Raye Dr
De Queen, AR 71832
Phone (870) 642-4343

NPI Registry JSON

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498608000000",
    "number": "1124549316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 W COLLIN RAYE DR",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718322502",
            "telephone_number": "870-584-4111",
            "fax_number": "870-584-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 W COLLIN RAYE DR",
            "city": "DE QUEEN",
            "state": "AR",
            "postal_code": "718322135",
            "telephone_number": "870-642-2273",
            "fax_number": "870-642-2162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE QUEEN MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-28",
        "last_updated": "2017-06-28",
        "status": "A",
        "authorized_official_last_name": "ICENHOWER",
        "authorized_official_first_name": "JERRAMY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "870-584-0272",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Queen, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; 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.