# CHICOT MEMORIAL MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHICOT MEMORIAL MEDICAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568787059
- **Legal business name:** CHICOT MEMORIAL MEDICAL CENTER
- **Authorized official:** SUSAN VAUGHN (CFO)
- **Authorized official phone:** (870) 265-5351

## Contact information

- **Practice address:** 2729 HWY 65 & 82 S, LAKE VILLAGE, AR 71653-6136
- **Practice address phone:** (870) 265-5351
- **Practice address fax:** (870) 265-2091
- **Mailing address:** 2729 HWY 65 & 82 S, LAKE VILLAGE, AR 71653-6136
- **Mailing address phone:** (870) 265-5351
- **Mailing address fax:** (870) 265-2091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | AR4650 | AR | Yes |

## Other

- **Enumeration date:** 03/29/2010
- **Last updated:** 11/04/2016