Northeast Arkansas Clinic Charitable Foundation, Inc.

Primary specialty

Oncology Clinic/CenterTaxonomy code 261QX0200X

Legal business name

NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC.

Doing business as

Fowler Family Center for Cancer Care

Practice address

4808 E Johnson Ave
Jonesboro, AR 72401-8413

Phone

(870) 936-8000

Fax

(870) 932-3608

NPI assigned

Dec 31, 2013

Last updated

Sep 29, 2020By the provider in NPPES

Organization subpart

No

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

• Fowler Family Center for Cancer Care Doing business as

Tax ID family

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

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

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1346661956
  NPD tax ID
• 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

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

{
    "created_epoch": "1388448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1912328428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-336-1485",
            "fax_number": "870-336-1484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4808 E JOHNSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724018413",
            "telephone_number": "870-936-8000",
            "fax_number": "870-932-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-31",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "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": "261QX0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5G237",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184473002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fowler Family Center for Cancer Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fowler Family Center for Cancer Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Northeast Arkansas Clinic Charitable Foundation, Inc. (NEA Baptist Clinic Dialysis Center/Hilltop)
• Northeast Arkansas Clinic Charitable Foundation, Inc. (NEA Baptist Mobile Health Unit)
• Northeast Arkansas Clinic Charitable Foundation, Inc. (NEA Baptist Clinic Center for Sleep Disorders)
• Northeast Arkansas Clinic Charitable Foundation, Inc. (NEA Baptist Clinic)
• Northeast Arkansas Clinic Charitable Foundation, Inc. (NEA Baptist Clinic)
• Northeast Arkansas Clinic Charitable Foundation, Inc. (NEA Baptist Clinic Anesthesia)
• Northeast Arkansas Clinic, P.a.
• Northeast Arkansas Clinic, P.a. (NEA Clinic Dialysis Center)
• Northeast Arkansas Clinic, PA (NEA Clinic)
• Northeast Arkansas Community Mental Health Center Inc (Mid-South Health Systems Inc)

• Oncology Clinic/Center in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Oncology Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.