NPIMap

Organization Active NPI

Mena Family Health Center

  • Family Medicine Physician
  • Mena, AR
National Provider Identifier
1447571047
Registry record updated Oct 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MENA FAMILY HEALTH CENTER
Practice address
1103 College Dr
Mena, AR 71953-2519
Phone
(479) 394-1414
Fax
(479) 243-2468
NPI assigned
Jun 17, 2010
Last updated
Oct 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2016

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

Authorized official

Name
Jay Quebedeaux
Title
Ceo
Phone
(479) 394-6100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1103 College Dr
Mena, AR 71953-2519

Mailing address

PO Box 1325
Mena, AR 71953-1325
Phone (479) 394-1414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100924000616 AR Part B Supplier - Clinic/Group Practice 3971629155 Receives reassigned benefits from 13 practitioners
Practice locations: Mena, AR

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1201 Mena St
#1
Mena, AR 71953
Phone (479) 437-3300

306 Hornbeck Ave
Mena, AR 71953
Phone (479) 243-6653

400 Crestwood Cir
Ste K
Mena, AR 71953
Phone (479) 394-6600

400 Crestwood Cir
Ste L
Mena, AR 71953
Phone (479) 243-2103

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1447571047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1325",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719531325",
            "telephone_number": "479-394-1414",
            "fax_number": "870-289-6993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 COLLEGE DR",
            "city": "MENA",
            "state": "AR",
            "postal_code": "719532519",
            "telephone_number": "479-394-1414",
            "fax_number": "479-243-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENA FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-17",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "QUEBEDEAUX",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "479-394-6100"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mena, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.