Organization
CHICOT MEMORIAL MEDICAL CENTER
Active
Other names
Chicot Memorial Medical Center Womens Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN VAUGHN (CFO)
(870) 265-5351
Entity
Organization
Contact information
Practice address
2729 HWY 65 & 82 S, LAKE VILLAGE, AR 71653-6136
(870) 265-5351
(870) 265-2091
Mailing address
2729 HWY 65 & 82 S, LAKE VILLAGE, AR 71653-6136
(870) 265-5351
(870) 265-2091
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-1328
MEDICARE PROVIDER NUMBER
—
01
—
04-Z328
MEDICARE PROVIDER NUMBER
—
05
—
181080105
—
AR
Enumeration date
05/27/2014
Last updated
07/09/2015
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