Organization
CHICOT MEMORIAL MEDICAL CENTER
Active
Parent organization
CHICOT MEMORIAL MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHICOT MEMORIAL MEDICAL CENTER
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
367500000X
Certified Registered Nurse Anesthetist
C00578
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182367002
—
AR
Enumeration date
03/29/2010
Last updated
06/25/2015
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