De Queen Medical Center Dialysis
NPI #1104356419 in De Queen, Arkansas
Provider Information
- NPI Number
- 1104356419
- Entity Type
- Organization
- Organization Name
- De Queen Medical Center Dialysis
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- DE QUEEN MEDICAL CENTER, INC
- Primary Specialty
- Clinic/Center - End-Stage Renal Disease (ESRD) Treatment
- Enumeration Date
- Jun 19, 2017
- Last Updated
- Jul 21, 2022
Practice Location
Authorized Official
- Name
- MR. JERRAMY ICENHOWER
- Title
- ADMINISTRATOR
- Phone
- (870) 584-0272
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - End-Stage Renal Disease (ESRD) Treatment — End-Stage Renal Disease (ESRD) Treatment |
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