NPIMap

Organization Active NPI

CBK Mother Goose

  • Early Intervention Provider Agency
  • Eudora, AR
National Provider Identifier
1134482649
Registry record updated Jun 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
License
12009 Issued in AR
Legal business name
CBK MOTHER GOOSE
Practice address
239 Swanigan St
Eudora, AR 71640-2437
Phone
(870) 222-4544
NPI assigned
Jun 19, 2012
Last updated
Jun 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2012

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

Authorized official

Name
Mrs. Sherry Jaggers Gregory
Title
Office Manager
Phone
(870) 222-4544

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Early Intervention Provider Agency 252Y00000X 12009 AR Primary

Addresses

Primary practice location

239 Swanigan St
Eudora, AR 71640-2437

Mailing address

PO Box 1051
MC Gehee, AR 71654-1051
Phone (870) 222-4544

Other identifiers 1

IdentifierTypeStateIssuer
191863724MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
CB King Uam Campus10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

239 Swanigan St
Eudora, AR 71640
Phone (870) 222-4544

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1134482649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1051",
            "city": "MC GEHEE",
            "state": "AR",
            "postal_code": "716541051",
            "telephone_number": "870-222-4544",
            "fax_number": "870-222-4557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 SWANIGAN ST",
            "city": "EUDORA",
            "state": "AR",
            "postal_code": "716402437",
            "telephone_number": "870-222-4544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CBK MOTHER GOOSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-19",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "GREGORY",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "JAGGERS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-222-4544",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "AR",
            "license": "12009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191863724",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eudora, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; 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.