OrganizationActive
De Queen Medical Center Dialysis
NPI 1104356419 · End-Stage Renal Disease (ESRD) Treatment Clinic/Center · De Queen, AR
Provider details
- NPI number
- 1104356419
- Entity type
- Organization
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- De Queen Medical Center, Inc
- Authorized official
- Jerramy Icenhower, Administrator
Practice location
1306 W Collin Raye Dr
De Queen, AR 71832-2502
Phone: (870) 584-4111
Fax: (870) 584-4100
Mailing address
1306 W Collin Raye Dr
De Queen, AR 71832-2502
Registry dates
- Enumerated
- 2017-06-19
- Last updated
- 2022-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.