Provider Demographics
NPI:1548357858
Name:REBSAMEN MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:REBSAMEN MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-985-7035
Mailing Address - Street 1:1400 BRADEN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3721
Mailing Address - Country:US
Mailing Address - Phone:501-985-7000
Mailing Address - Fax:501-985-7407
Practice Address - Street 1:1400 BRADEN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3721
Practice Address - Country:US
Practice Address - Phone:501-985-7000
Practice Address - Fax:501-985-7407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR3795314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR15329OtherBLUE CROSS AR PROVIDER NO
AR045329Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER