Healthcare Provider Details

I. General information

NPI: 1164720868
Provider Name (Legal Business Name): MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MEDICAL DR
BLYTHEVILLE AR
72315-1425
US

IV. Provider business mailing address

1100 MEDICAL DR
BLYTHEVILLE AR
72315-1425
US

V. Phone/Fax

Practice location:
  • Phone: 870-762-6725
  • Fax:
Mailing address:
  • Phone: 870-762-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS L RAYMER
Title or Position: CEO
Credential:
Phone: 870-838-7460