NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. (NPI# 1912328428) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912328428 |
| Entity Type | Organization |
| Organization Name | NORTHEAST ARKANSAS CLINIC CHARITABLE FOUNDATION, INC. |
| Other Organization Name | FOWLER FAMILY CENTER FOR CANCER CARE |
| Practice Address |
4808 E Johnson Ave Jonesboro AR 72401-8413 |
| Mailing Address |
Po Box 1960 Jonesboro AR 72403-1960 |
| Practice Telephone | 8709368000 |
| Practice Fax Number | 8709323608 |
| Mailing Telephone | 8703361485 |
| Mailing Fax Number | 8703361484 |
| Enumeration Date | 2013-12-31 |
| Last Update Date | 2020-09-29 |
| Authorized Official Name | MR. GREGORY M. DUCKETT (SR. VP / CORPORATE SECRETARY) |
| Authorized Official Telephone | 9012275233 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QX0200X |
Clinic/Center Specialization: Oncology |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 184473002 | 05 | |
| AR | BCBS | 5G237 | 01 |
| Other Name | Type Code |
|---|---|
| Fowler Family Center for Cancer Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033491519 | Northeast Arkansas Clinic Charitable Foundation, Inc. | Clinic/Center | 4909 East Johnson Ave., Jonesboro, AR 72401 | 2011-09-12 |
| 1528399755 | Northeast Arkansas Clinic Charitable Foundation, Inc. | Clinic/Center | 1118 Windover, Jonesboro, AR 72401-6155 | 2010-01-28 |
| 1801127030 | Northeast Arkansas Clinic Charitable Foundation, Inc. | Clinical Medical Laboratory | 4802 E. Johnson Avenue, Jonesboro, AR 72401 | 2010-01-28 |
| 1932503372 | Northeast Arkansas Clinic Charitable Foundation, Inc. | Durable Medical Equipment & Medical Supplies | 4800 E Johnson Ave, Jonesboro, AR 72401-8413 | 2014-10-14 |
| 1992036032 | Northeast Arkansas Clinic Charitable Foundation, Inc. | Anesthesiology | 4800 E Johnson Ave, Jonesboro, AR 72401-8413 | 2010-01-28 |
| 1861721839 | Northeast Arkansas Clinic Charitable Foundation, Inc. | Clinic/Center | 4802 E Johnson Ave, Jonesboro, AR 72401-8413 | 2009-12-21 |
| Street Address |
4808 E JOHNSON AVE |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401-8413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689643751 | Ronald J Blachly | Internal Medicine | 4808 E Johnson Ave, Jonesboro, AR 72401-8413 | 2006-03-14 |
| 1124231816 | Scott A. Dorroh | Internal Medicine | 4808 E Johnson Ave, Hem/onc Dept., Jonesboro, AR 72401 | 2007-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| Taxonomy Code | 261QX0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Oncology |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment and prescriptive services related to cancerous conditions. Services include chemotherapy infusions and monitoring of implanted chemotherapeutic agents. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568001386 | Jefferson Regional Cancer Center | Clinic/Center | 1609 W 40th Ave Ste 205, Pine Bluff, AR 71603-6367 | 2019-12-26 |
| 1184911901 | White County Medical Center | Clinic/Center | 415 Rodgers Dr Ste A, Searcy, AR 72143-7434 | 2011-06-30 |
| 1821018417 | Central Arkansas Hematology and Oncology Clinic, Pa | Clinic/Center | 133 Harmony Park Circle, Hot Springs, AR 71913 | 2006-07-19 |
| 1124407077 | Kota Cancer Clinic Pllc | Clinic/Center | 180 Medical Park Pl, Suite 201, Hot Springs, AR 71901-8065 | 2015-05-26 |
| 1851608665 | Joseph M Beck II Md Pa | Clinic/Center | 500 S University Ave, Suite 512, Little Rock, AR 72205-5302 | 2010-09-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.