Organization
CHICOT MEMORIAL MEDICAL CENTER
Active
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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