Northeast Arkansas Clinic Charitable Foundation, Inc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

MC-2122 Issued in AR

Legal business name

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC

Doing business as

NEA Baptist Clinic

Practice address

4802 E. Johnson Avenue
Jonesboro, AR 72401

Phone

(870) 936-8000

NPI assigned

Dec 27, 2013

Last updated

Sep 30, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

BAPTIST MEMORIAL HEALTH CARE CORP.As reported in NPPES

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

Authorized official

Name

Mr. Gregory M. Duckett

Title

Sr. VP / Corporate Secretary

Phone

(901) 227-5233

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• NEA Baptist Clinic Doing business as

Tax ID family

Northeast Arkansas Clinic7 organizations share this tax ID, including this one

Part of

Baptist Memorial Health Care Corp

Other organizations with this tax ID 6

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

• Northeast Arkansas Clinic Charitable Foundation, Inc

  dba NEA Baptist Clinic Imaging Center

  • Radiology Clinic/Center
  • Jonesboro, AR
  • NPI 1790016418
  NPD tax ID
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic Dialysis Center/Hilltop

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Jonesboro, AR
  • NPI 1033491519
  NPD tax ID
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Mobile Health Unit

  • Mobile Mammography Clinic/Center
  • Jonesboro, AR
  • NPI 1417721689
  NPD tax ID
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic Center for Sleep Disorders

  • Sleep Disorder Diagnostic Clinic/Center
  • Jonesboro, AR
  • NPI 1528399755
  NPD tax ID
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic

  • Clinical Medical Laboratory
  • Jonesboro, AR
  • NPI 1801127030
  NPD tax ID
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba Fowler Family Center for Cancer Care

  • Oncology Clinic/Center
  • Jonesboro, AR
  • NPI 1912328428
  NPD tax ID

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

{
    "created_epoch": "1388102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1346661956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N HUMPHREYS BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381202177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 E. JOHNSON AVENUE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-936-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAPTIST MEMORIAL HEALTH CARE CORP.",
        "enumeration_date": "2013-12-27",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "SR. VP / CORPORATE SECRETARY",
        "authorized_official_telephone_number": "901-227-5233",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AR",
            "license": "MC-2122",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184473002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5G237",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEA Baptist Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NEA Baptist Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• North Central IV & Respiratory Specialists
• North Central IV & Respiratory Specialists LLC
• Morgan Elaine Northcutt, LAC, EDS, SPS, NCSP
• Northeast Ark Int Med C
• Northeast Arkansas Clinic Charitable Foundation, Inc (NEA Baptist Clinic Dialysis Center)
• Northeast Arkansas Clinic Charitable Foundation, Inc (NEA Baptist Clinic Imaging Center)
• Northeast Arkansas Clinic Charitable Foundation, Inc (Nea Baptist Clinic Matthews)
• Northeast Arkansas Clinic Charitable Foundation, Inc (NEA Baptist Urgent Care Plus)
• Northeast Arkansas Clinic Charitable Foundation, Inc. (NEA Baptist Clinic Dialysis Center/Hilltop)

• Multi-Specialty Clinic/Center in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Multi-Specialty Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.