Organization
DE QUEEN MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN A. MATHESON (CEO)
(870) 584-0272
Entity
Organization
Contact information
Practice address
1306 W COLLIN RAYE DR, DE QUEEN, AR 71832-2502
(870) 584-0272
(870) 584-4100
Mailing address
1306 W COLLIN RAYE DR, DE QUEEN, AR 71832-2502
(870) 584-0272
(870) 584-4100
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
AR4365
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157501002
—
AR
05
—
200064800A
—
OK
01
—
5F418
BLUE CROSS
AR
Enumeration date
02/28/2007
Last updated
05/05/2010
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