Provider Demographics
NPI:1548221377
Name:HEBER SPRINGS CLINIC
Entity type:Organization
Organization Name:HEBER SPRINGS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-362-2414
Mailing Address - Street 1:401 W SEARCY ST
Mailing Address - Street 2:P. O. BOX 1570
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3842
Mailing Address - Country:US
Mailing Address - Phone:501-362-2414
Mailing Address - Fax:501-362-7068
Practice Address - Street 1:401 W SEARCY ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3842
Practice Address - Country:US
Practice Address - Phone:501-362-2414
Practice Address - Fax:501-362-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125447002Medicaid
AR5B517Medicare UPIN