GPN Jacksonville LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

GPN JACKSONVILLE LLC

Practice address

1400 Braden St
ER Dept
Jacksonville, AR 72076-3721

Phone

(501) 985-7315

NPI assigned

Dec 19, 2011

Organization subpart

No

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

Authorized official

Name

Samuel D Huckabee

Title

Ceo

Phone

(318) 629-5349

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marc Edwin Borton, MD

  • Emergency Medicine Physician
  • Eureka Springs, AR
  • NPI 1275639759
  NPD (past)

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1376812487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3925",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711333925",
            "telephone_number": "800-684-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BRADEN ST",
            "address_2": "ER DEPT",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720763721",
            "telephone_number": "501-985-7315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GPN JACKSONVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-19",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "HUCKABEE",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-629-5349"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "616847700",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "191242002",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE",
            "identifier": "DS4118",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Logan Gilbertson, OTR4172
• Mika Tamara Gill, LMSW
• April Glasgow, QBHP
• John Glenn
• Isabella Noelle Gordon
• George Thompson Gray III, D.O.
• Gregory K. Bollen, DDS, P.a.
• Deana Grisham, LPN
• Josh Guerra, QBHP
• Ashlyne Guinn, QBHP

• Emergency Medicine Physician in Jacksonville, AR
• Providers in Jacksonville, AR by specialty
• Emergency Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.