NPIMap

Organization Active NPI

East Arkansas Family Health Center, Inc

Doing business as East Arkansas Family Health Center-Marvell

  • Federally Qualified Health Center (FQHC)
  • Marvell, AR
National Provider Identifier
1508379249
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST ARKANSAS FAMILY HEALTH CENTER, INC
Doing business as
East Arkansas Family Health Center-Marvell
Practice address
1008 W Main St
Marvell, AR 72366-9486
Phone
(870) 735-3842
NPI assigned
Nov 15, 2017
Last updated
Nov 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Debbie Brown
Title
Billing/Credentialing Manager
Phone
(870) 733-6388

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1008 W Main St
Marvell, AR 72366-9486

Mailing address

900 N 7TH St
West Memphis, AR 72301-2001
Phone (870) 735-3842

Other names 1

  • East Arkansas Family Health Center-Marvell Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171127000226 AR Part A Provider - Federally Qualified Health Center (FQHC) 1052390390 Practice locations: Marvell, AR
O20171208002213 AR Part B Supplier - Clinic/Group Practice 1052390390 Receives reassigned benefits from 13 practitioners
Practice locations: Marvell, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508379249. Details of each certification follow.

Federally qualified health center certification: CCN 041936

Legal name
EAST ARKANSAS FAMILY HEALTH CENTER, INC
Doing business as
EAST ARKANSAS FAMILY HEALTH CENTER-MARVELL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 27, 2017
Last certification
Nov 27, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 1, 1973 in AR
Enrollment address
1008 W Main St
Marvell, AR 72366-9486

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2141159East Arkansas Family Health Center-Marvell1008 West Main Street, Marvell, AR 72366Certificate of waiverDec 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
East Arkansas Family Health Center17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Reena Holmes Individual Corporate OfficerCfo Jan 1, 2021
Susan Ward Jones Individual Corporate OfficerCeo Nov 1, 2006
Corporate Director Nov 1, 2006
Operational/Managerial Control Nov 1, 2006
Larry Robinson Individual Corporate DirectorBoard Member Jun 18, 2014
Cynthia Conner Individual Corporate DirectorBoard Member Sep 9, 2016
Randall S Burcham Individual Corporate DirectorBoard Member May 26, 2015
Danise Chandler Individual Corporate DirectorBoard Member Apr 24, 2017
Kyle Miller Individual Corporate DirectorBoard Member Sep 23, 2019
Sara Joplin Individual Corporate DirectorBoard Member Aug 24, 2020
Sandra Teague Individual Corporate DirectorBoard Member Jul 23, 2012
Tracy Evans Individual Corporate DirectorBoard Chair May 26, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Marion School District School Based Health CenterMarion, AR, CCN 041941 Federally qualified health center Operational/Managerial Control (100%) Aug 13, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1508379249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 N 7TH ST",
            "city": "WEST MEMPHIS",
            "state": "AR",
            "postal_code": "723012001",
            "telephone_number": "870-735-3842",
            "fax_number": "870-394-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 W MAIN ST",
            "city": "MARVELL",
            "state": "AR",
            "postal_code": "723669486",
            "telephone_number": "870-735-3842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST ARKANSAS FAMILY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-15",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "870-733-6388"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Arkansas Family Health Center-Marvell",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marvell, AR

Sources for this page

Verify at the official NPI Registry.