David Blackburn, MD
Individual provider Active NPI Family Medicine Physician · Rector, AR
NPI 1295239408 · NPPES record last updated Oct 1, 2021
Key facts
- NPI
- 1295239408
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E13950 (AR)
- Practice address
- 715 E 9TH St
Rector, AR 72461-2705 - Phone
- (870) 595-3596
- NPI assigned
- Mar 21, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210706000509 | AR | Practitioner - Family Practice | 3173879145 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E13950 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Piggott Community Hospital | Current |
Accepting new patients | |
| Piggott Community Hospital | Family Medicine | Current |
Accepting new patients |
Locations
1206 Gordon Duckworth Dr
Piggott, AR 72454
Phone (870) 598-3881
715 E 9th St
Rector, AR 72461
Phone (870) 595-3596
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | E13950 | AR | Yes |
Addresses
Primary practice location
715 E 9TH St
Rector, AR 72461-2705
Mailing address
1206 Gordon Duckworth Dr
Piggott, AR 72454-1911
Phone (870) 598-3881
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 271052001 | Medicaid | AR |
Other providers in Rector, AR
- Advanced Therapy Services, LLC
- Daniel Miller Blackshare
- Sammy Bryan Blackshare
- David Brandon Blount
- Kocaina Bashe Blount
- Kristen Kay Bohr
All providers in Rector, 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 Oct 1, 2021. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.