Provider Demographics
NPI:1154906162
Name:MITCHELL MEDICAL
Entity type:Organization
Organization Name:MITCHELL MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-642-8818
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:HORATIO
Mailing Address - State:AR
Mailing Address - Zip Code:71842-0345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-3706
Practice Address - Country:US
Practice Address - Phone:870-642-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR125229001Medicaid
AR1942208277OtherPROVIDER NPI
AR1568061828OtherNURSE PRACTITIONER NPI