Provider Demographics
NPI:1366608895
Name:EAST ARKANSAS FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:EAST ARKANSAS FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-735-3842
Mailing Address - Street 1:900 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-2001
Mailing Address - Country:US
Mailing Address - Phone:870-735-3842
Mailing Address - Fax:870-394-4817
Practice Address - Street 1:102 W BROAD ST
Practice Address - Street 2:
Practice Address - City:LEPANTO
Practice Address - State:AR
Practice Address - Zip Code:72354-2200
Practice Address - Country:US
Practice Address - Phone:870-735-3842
Practice Address - Fax:870-732-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122837749Medicaid