Organization
GPN JACKSONVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL D HUCKABEE (CEO)
(318) 629-5349
Entity
Organization
Contact information
Practice address
1400 BRADEN ST, ER DEPT, JACKSONVILLE, AR 72076-3721
(501) 985-7315
Mailing address
PO BOX 3925, SHREVEPORT, LA 71133-3925
(800) 684-0052
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191242002
—
AR
01
—
616847700
DEPT OF LABOR
—
01
—
DS4118
RAILROAD MCARE
—
Enumeration date
12/19/2011
Last updated
08/27/2012
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