De Queen Medical Center Dialysis
NPI 1104356419 · End-Stage Renal Disease (ESRD) Treatment Clinic/Center · De Queen, AR
De Queen Medical Center Dialysis is a End-Stage Renal Disease (ESRD) Treatment Clinic/Center organization in De Queen, AR (NPI 1104356419).
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
- Organization subpart
- Yes
- Authorized official
- Jerramy Icenhower, Administrator(870) 584-0272
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2017-06-19
- Last updated
- 2022-07-21
Frequently asked questions
- What is De Queen Medical Center Dialysis's NPI number?
- De Queen Medical Center Dialysis's National Provider Identifier (NPI) is 1104356419, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is De Queen Medical Center Dialysis?
- De Queen Medical Center Dialysis is classified in the NPPES registry as End-Stage Renal Disease (ESRD) Treatment Clinic/Center (Ambulatory Health Care Facilities).
- Where is De Queen Medical Center Dialysis located?
- De Queen Medical Center Dialysis's practice location on file with NPPES is 1306 W Collin Raye Dr, De Queen, AR 71832-2502.
- What is De Queen Medical Center Dialysis's phone number?
- The practice phone number listed in the NPPES registry for De Queen Medical Center Dialysis is (870) 584-4111.
- Who is the authorized official for De Queen Medical Center Dialysis?
- The authorized official listed on De Queen Medical Center Dialysis's NPPES record is Jerramy Icenhower, Administrator. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is De Queen Medical Center Dialysis's NPI active?
- Yes — De Queen Medical Center Dialysis's NPI (1104356419) is active in the NPPES registry as of the last update on 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.