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DE QUEEN MEDICAL CENTER DIALYSIS
NPI 1104356419
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in De Queen, AR

Active since June 19, 2017
1306 W COLLIN RAYE DR, DE QUEEN, AR 71832(870) 584-4111(870) 584-4100 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 21, 2022, Jun 19, 2017 (2 updates tracked since 2017).

About De Queen Medical Center Dialysis NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DE QUEEN MEDICAL CENTER DIALYSIS (NPI 1104356419) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in De Queen, Arkansas and active in the NPI registry since June 2017. The organization lists Jerramy Icenhower, Administrator, as its authorized official.

NPPES Registry Identity

NPI1104356419
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameDE QUEEN MEDICAL CENTER DIALYSIS
Location Address1306 W COLLIN RAYE DRDe Queen, AR 71832-2502
Mailing Address1306 W Collin Raye DrDe Queen, AR 71832-2502 · (870) 584-4111 · Fax (870) 584-4100
Phone(870) 584-4111
Fax(870) 584-4100
Organization SubpartYesParent: De Queen Medical Center, Inc
Authorized OfficialJerramy IcenhowerAdministrator · (870) 584-0272
Enumeration DateJune 19, 2017
Last NPPES UpdateJuly 21, 20222 updates tracked since enumeration
✔ NPI 1104356419 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
1306 W COLLIN RAYE DR, De Queen, AR 71832
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Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KIMBERLY HENRITZE COTA
Occupational Therapy Assistant
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 648-4990
DE QUEEN MEDICAL CENTER INC
General Acute Care Hospital (Critical Access)
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 584-4111
DE QUEEN MEDICAL CENTER INC
General Acute Care Hospital (Critical Access)
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 854-4111
DE QUEEN MEDICAL CENTER INC
Radiology (Diagnostic Radiology)
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 584-0272
DEADRE BRADY
Physical Therapy Assistant
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 642-4990
DR. VIRGIL L HAYDEN MD
Obstetrics & Gynecology
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 642-7572
DE QUEEN MEDICAL CENTER INC
Rehabilitation Unit
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 584-4111
EMCARE PHYSICIAN PROVIDERS, INC
Emergency Medicine
1306 W COLLIN RAYE DR
DE QUEEN, AR 71832
Sevier County (870) 584-4111

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is De Queen Medical Center Dialysis's NPI number?

The NPI number for De Queen Medical Center Dialysis is 1104356419. It was assigned to this organization in the NPPES registry on June 19, 2017.

Where is De Queen Medical Center Dialysis located?

De Queen Medical Center Dialysis is located at 1306 W Collin Raye Dr, De Queen, AR 71832. The listed phone number is (870) 584-4111.

What is De Queen Medical Center Dialysis's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

When was this NPI record last updated?

The NPPES record for De Queen Medical Center Dialysis was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.