Provider Demographics
NPI:1629017405
Name:CABUN RURAL HEALTH SERVICES, INC
Entity type:Organization
Organization Name:CABUN RURAL HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, LRT, RMC
Authorized Official - Phone:870-798-3515
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:AR
Mailing Address - Zip Code:71921-0218
Mailing Address - Country:US
Mailing Address - Phone:870-342-5006
Mailing Address - Fax:870-342-5802
Practice Address - Street 1:329 N HILL ST
Practice Address - Street 2:
Practice Address - City:AMITY
Practice Address - State:AR
Practice Address - Zip Code:71921-9635
Practice Address - Country:US
Practice Address - Phone:870-342-5006
Practice Address - Fax:870-342-5802
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CABUN RURAL HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143650749Medicaid
AR143650749Medicaid
AR57077Medicare PIN