Organization
DE QUEEN MEDICAL CENTER DIALYSIS
Active
Parent organization
DE QUEEN MEDICAL CENTER, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DE QUEEN MEDICAL CENTER, INC
Authorized official
MR. JERRAMY ICENHOWER (ADMINISTRATOR)
(870) 584-0272
Entity
Organization
Contact information
Practice address
1306 W COLLIN RAYE DR, DE QUEEN, AR 71832-2502
(870) 584-4111
(870) 584-4100
Mailing address
1306 W COLLIN RAYE DR, DE QUEEN, AR 71832-2502
(870) 584-4111
(870) 584-4100
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
06/19/2017
Last updated
07/21/2022
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