East Arkansas Family Health Center, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Earle, AR
NPI 1912370198 · NPPES record last updated Nov 18, 2020
Key facts
- NPI
- 1912370198
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- EAST ARKANSAS FAMILY HEALTH CENTER, INC
- Practice address
- 216 Arkansas St
Earle, AR 72331-2217 - Phone
- (870) 735-3842
- NPI assigned
- Nov 10, 2015
- Organization subpart
- No
Authorized official
- Name
- Susan Ward-Jones
- Title
- Ceo
- Phone
- (870) 733-6388
Owners & managing parties with NPI records 2
-
Randall Scott Burcham, MSSW LCSW
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 16
Practitioners 32
-
Holli Nicole Banks-Giles, M.D.
-
Lindsey Morgan Bryan, APRN
-
Norman Clifford Denton, M.D.
-
Tameka Granberry, LCSW
-
Adrienne D Hatchett, M.D.
-
Ursula Desha Logan, FNP
-
Tanja Mead, MSN, FNP
-
Cynthia Joyce Robinson, APRN
-
Ellen L Speak, APN
-
Racheal Antonette Mitchell, FNP-BC
-
Patricia A Devine, LCSW
-
Emiley Kerns, APRN, FNP-C
-
Shirley Alema Tanner, ANP
-
Geraldine G. Campbell, APRN-BC
-
Yasir U. Afzal, M.D.
-
Kristi Renee Allen, A.N.P.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Federally qualified health center certification: CCN 041910
- Legal name
- EAST ARKANSAS FAMILY HEALTH CENTER, INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 13, 2016
- Last certification
- Jan 13, 2016
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 10, 1973 in AR
- Enrollment address
- 216 Arkansas St
Earle, AR 72331-2217
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Reena Holmes |
Corporate Officer |
Jan 1, 2021 | |
| Susan Ward Jones |
Corporate Officer |
Nov 1, 2006 | 100% |
| W-2 Managing Employee | Nov 1, 2006 | 100% | |
| Operational/Managerial Control | Nov 1, 2006 | ||
| Larry Robinson |
Corporate Director |
Jun 18, 2014 | |
| Cynthia Conner |
Corporate Director |
Sep 9, 2016 | |
| Randall S Burcham |
Corporate Director |
May 26, 2015 | |
| Danise Chandler |
Corporate Director |
Apr 24, 2017 | |
| Kyle Miller |
Corporate Director |
Sep 23, 2019 | |
| Sara Joplin |
Corporate Director |
Aug 24, 2020 | |
| Sandra Teague |
Corporate Director |
Oct 23, 2012 | |
| Tracy Evans |
Corporate Director |
May 26, 2015 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Marion School District School Based Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Aug 13, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160114002062 | AR | Part B Supplier - Clinic/Group Practice | 1052390390 |
Receives reassigned benefits from 22 practitioners Practice locations: Earle, AR |
| O20160114002453 | AR | Part a Provider - Federally Qualified Health Center (FQHC) | 1052390390 | Practice locations: Earle, AR |
National Provider Directory
- Tax ID family
- E Ar Family Health Ctr Inc
Locations
216 Arkansas St
Earle, AR 72331
Phone (870) 792-7676
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
216 Arkansas St
Earle, AR 72331-2217
Mailing address
900 N 7TH St
West Memphis, AR 72301-2001
Phone (870) 735-3842
Other names
- Earle Family Health Center
Other providers in Earle, AR
- Carol Riley Clark
- Clarks Family Pharmacy
- Margaret Cummings
- Earle School District
- Tracey Eason
- East Arkansas Family Health Center, Inc.
- Jessie J Fong
- Fongs Drugs
- Marlena Female Gee
- Shameka Greer
All providers in Earle, AR · Federally Qualified Health Center (FQHC) in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.