Healthcare Provider Details

I. General information

NPI: 1699945147
Provider Name (Legal Business Name): BAXTER COUNTY REGIONAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 ASH FLAT DR
ASH FLAT AR
72513-0790
US

IV. Provider business mailing address

970 ASH FLAT DR
ASH FLAT AR
72513-0790
US

V. Phone/Fax

Practice location:
  • Phone: 870-994-7301
  • Fax: 870-994-7488
Mailing address:
  • Phone: 870-994-7301
  • Fax: 870-994-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAR3827
License Number StateAR

VIII. Authorized Official

Name: DEBRA HENRY
Title or Position: CFO
Credential:
Phone: 870-508-1003