Healthcare Provider Details

I. General information

NPI: 1194009019
Provider Name (Legal Business Name): MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N DIVISION ST
BLYTHEVILLE AR
72315-1448
US

IV. Provider business mailing address

1520 N DIVISION ST
BLYTHEVILLE AR
72315-1448
US

V. Phone/Fax

Practice location:
  • Phone: 870-838-7460
  • Fax: 870-838-7493
Mailing address:
  • Phone: 870-838-7460
  • Fax: 870-838-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberAR4562
License Number StateAR

VIII. Authorized Official

Name: MR. CHRIS L RAYMER
Title or Position: COO/CNO
Credential: RN
Phone: 870-838-7460