Healthcare Provider Details

I. General information

NPI: 1659369130
Provider Name (Legal Business Name): LITTLE RIVER MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 W LOCKE ST
ASHDOWN AR
71822-3325
US

IV. Provider business mailing address

451 W LOCKE ST
ASHDOWN AR
71822-3325
US

V. Phone/Fax

Practice location:
  • Phone: 870-898-5011
  • Fax: 870-898-4172
Mailing address:
  • Phone: 870-898-5011
  • Fax: 870-898-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAR4204
License Number StateAR

VIII. Authorized Official

Name: MR. JAMES DOWELL
Title or Position: CEO
Credential:
Phone: 870-898-5011