DE QUEEN MEDICAL CENTER DIALYSIS – NPI #1104356419
Clinic/Center

DE QUEEN MEDICAL CENTER DIALYSIS is an AHC clinic located in DE QUEEN, AR. NPPES has assigned the NPI number 1104356419 to DE QUEEN MEDICAL CENTER DIALYSIS on June 19, 2017. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QE0700X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment

The NPI profile was previously updated about 4 years ago on Jul 21, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for DE QUEEN MEDICAL CENTER DIALYSIS below.

NPI Profile for
DE QUEEN MEDICAL CENTER DIALYSIS

NPI Number
1104356419
Enumeration Date

(about 9 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
DE QUEEN MEDICAL CENTER DIALYSIS
Primary location
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832-2502
Phone: (870) 584-4111 Fax: (870) 584-4100
Mailing address
Same as primary location
Organization Subpart
Yes - DE QUEEN MEDICAL CENTER DIALYSIS is subpart of another organization.
Authorized Official
JERRAMY ICENHOWER
ADMINISTRATOR
Phone: (870) 584-0272
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QE0700X
- Clinic/Center / End-Stage Renal Disease (ESRD) Treatment (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.