NPIMap

Organization Active NPI

Chicot Memorial Medical Center

  • Dental Clinic/Center
  • Lake Village, AR
National Provider Identifier
1861901985
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
CHICOT MEMORIAL MEDICAL CENTER
Practice address
2729 S. Hwy 65 82
Lake Village, AR 71653
Phone
(870) 265-5351
NPI assigned
Sep 20, 2017
Organization subpart
Yes
Parent organization
CHICOT MEMORIAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Susan Vaughn
Title
Cfo
Phone
(870) 265-9229

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2729 S. Hwy 65 82
Lake Village, AR 71653

Mailing address

2729 S Highway 65 82
Lake Village, AR 71653-6136

Other names 1

  • Chicot Memorial Medical Center Dental Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Chicot Mem Med5 organizations share this tax ID, including this one
Part of
Chicot Mem Med

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1505865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1861901985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2729 S HIGHWAY 65 82",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "716536136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2729 S. HWY 65 82",
            "city": "LAKE VILLAGE",
            "state": "AR",
            "postal_code": "71653",
            "telephone_number": "870-265-5351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICOT MEMORIAL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHICOT MEMORIAL MEDICAL CENTER",
        "enumeration_date": "2017-09-20",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "VAUGHN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-265-9229"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chicot Memorial Medical Center Dental Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Village, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.