DR. JACK COOK WILSON (NPI# 1518941517) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518941517 |
| Entity Type | Individual |
| Full Name | DR. JACK COOK WILSON |
| Credential | M.D. |
| Practice Address |
612 E 9th St Mountain Home AR 72653-4804 |
| Mailing Address |
924 Capitol Dr Mountain Home AR 72653-2053 |
| Practice Telephone | 8704243652 |
| Mailing Telephone | 8704243652 |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | C3223 | AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | QUALCHOICE PROVIDER ID # | 16022000000 | 01 |
| AR | BLUE CROSS BLUE SHIELD ID | 55740 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114241239 | Jack H Wilson | Counselor | 11730 Highway 9 West, Stigler, OK 74462 | 2010-03-18 |
| 1821122102 | Jack A. Wilson | Dentist | 2200 Interstate 20 W Ste 200, Arlington, TX 76017-1649 | 2007-03-16 |
| 1396806519 | Jack Wilson | Pharmacist | 8823 Avenue L, Brooklyn, NY 11236-4781 | 2006-12-12 |
| 1790756542 | Jack Edward Wilson | Surgery | 3 Walnut St Ste 100, Lemoyne, PA 17043 | 2006-01-30 |
| 1356349559 | Jack Kenney Wilson Jr. | Internal Medicine | 637 S Kerr Ave, Wilmington, NC 28403-8423 | 2005-07-12 |
| 1043216807 | Jack Anthony Wilson | Dental Hygienist | 2654 Stacey Way, National City, CA 91950-7760 | 2005-06-24 |
| 1497949929 | Jack L Wilson | Dentist | 1721 S Cleveland Ave, Suite 100, Sioux Falls, SD 57103-5501 | 2007-08-28 |
| 1316002314 | Jack Wilson | Dentist | 12320 N 32nd St, Suite 1, Phoenix, AZ 85032-7154 | 2006-12-27 |
| 1598774465 | Jack W. Wilson | Dentist | 534 Luzerne St, Mount Ida, AR 71957-9449 | 2006-08-07 |
| 1033125299 | Jack M Wilson | Emergency Medicine | 6655 Alvarado Rd, San Diego, CA 92120-5208 | 2006-07-31 |
| Street Address |
612 E 9TH ST |
| City | MOUNTAIN HOME |
| State | AR |
| Zip Code | 72653-4804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619513934 | Maranda Hickman | Physical Therapy Assistant | 347 Hwy 62 East College Plaza, Mountain Home, AR 72653 | 2019-11-21 |
| 1659929156 | Gale E Bacan | Technician | 1703 Monroe Ave, Mountain Home, AR 72653 | 2019-08-28 |
| 1891259321 | Kidspiration Pediatric Therapy Services | Clinic/Center | 710 Bradley Dr., Mountain Home, AR 72653 | 2019-01-29 |
| 1093279275 | Piper's Vision Xpress, LLC | Optometrist | 50 Paul Wood Lane, Mountian Home, AR 72653 | 2019-01-22 |
| 1346769155 | Heather Bollinger | Nurse Practitioner | 65 Walmart Drive, C/o Clinic At Walmart, Mountain Home, AR 72653 | 2017-09-12 |
| 1447774989 | Natalie D Ahrent | Physical Medicine & Rehabilitation | 804 Coley Dr, Mountain Home, AR 72653 | 2017-07-26 |
| 1417486028 | Andrew David Hatman | Case Manager/Care Coordinator | 1349 Hampshire Circle, Mountain Home, AR 72653 | 2017-06-07 |
| 1568848315 | Taylor Chiropractic Plc | Health Maintenance Organization | 103 S Main St Ste 5, Mountain Home, AR 72653 | 2015-08-04 |
| 1942606306 | Harps Food Stores, Inc | Pharmacy | 2089 Highway 62 West, Mountain Home, AR 72653 | 2014-11-13 |
| 1972920726 | Lavonne Armstrong | Counselor | 8 Medical Plaza, Mountain Home, AR 72653 | 2014-03-18 |
| Find all providers in zip 72653 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205270949 | Relief Center, LLC | Family Medicine | 40 Plaza Way Ste 30, Mountain Home, AR 72653-9083 | 2013-04-24 |
| 1841533932 | Alex Qader | Family Medicine | Bldg.160 Mountain Home, Mountain Home, TN 37684 | 2013-03-27 |
| 1770628471 | James Andrew Warr | Family Medicine | 405 Buttercup Drive, Mountain Home, AR 72653-2910 | 2007-02-20 |
| 1831206135 | Richard Frederick Starkey | Family Medicine | 805 N 6th E, Mountain Home, ID 83647-2207 | 2006-08-23 |
| 1760426746 | John T Leslie | Family Medicine | 675 Highway 62 E, Mountain Home, AR 72653-3207 | 2006-06-16 |
| 1114979440 | David L Lane | Family Medicine | Building 160 Dogwood Avenue, Mountain Home, TN 37684 | 2006-05-16 |
| 1225087398 | Mountain-home Medical Group, Pa | Family Medicine | 353 East 8th Street, Mountain Home, AR 72653 | 2006-05-08 |
| 1710935341 | Susanne Toyne | Family Medicine | Corner of Sidney and Lamont, Mountain Home, TN 37684-4000 | 2006-05-05 |
| 1144294992 | Edward L White | Family Medicine | 614 Northtown, Mountain Home, AR 72653-3105 | 2006-02-16 |
| 1356311617 | Kevin J Adkins | Family Medicine | 614 North Town, Mountain Home, AR 72653-3105 | 2006-01-26 |
| Find all providers in MOUNTAIN HOME | ||||
| City | MOUNTAIN HOME |
| Zip Code | 72653 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.