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Jack T Fendley

  • Male

Medical Specialty

Professional ID

  • NPI: 1821074592
  • PECOS ID: 3971786013
  • Enrollment ID: I20110404000839
  • Credential(MD, DO, DPM):
  • Medical School:
  • Medical School Graduation Year: 1972

Hospital Service

  • Hospital CCN1: 040137
  • Business Name (LBN)1: St Vincent Medical Centernorth
  • Hospital CCN2: 040036
  • Business Name (LBN)2: Baptist Health Medical Center North Little Rock
  • Hospital CCN3: 040114
  • Business Name (LBN)3: Baptist Health Medical Center-little Rock
  • Hospital CCN4: 040007
  • Business Name (LBN)4: Chi-st Vincent Infirmary
  • Hospital CCN5: 041313
  • Business Name (LBN)5: Ozark Health

Medical Practices

  • Organization Name: North Pulaski Diagnostic Clinic
  • Group Practice ID assigned by PECOS: 8527241660
  • Number of Group Practice member: 3

Location

  • Address1: 2215 Wildwood Ave
  • Address2: Suite 201
  • City: Sherwood
  • State: Arkansas
  • Zip Code: 72120
  • Phone Number: (501)833-8400

Medicare

  • Medicare Assignment: Yes
  • Report Quality of Care to Physician Quality Reporting System (PQRS): Yes
  • Used Electronic health record (EHR): Yes