Healthcare Provider Details

I. General information

NPI: 1710597778
Provider Name (Legal Business Name): OUACHITA COUNTY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 CALIFORNIA AVE SW
CAMDEN AR
71701-4604
US

IV. Provider business mailing address

PO BOX 797
CAMDEN AR
71711-0797
US

V. Phone/Fax

Practice location:
  • Phone: 870-836-1296
  • Fax: 870-836-1041
Mailing address:
  • Phone: 870-836-1296
  • Fax: 870-836-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE HIVELY
Title or Position: DIRECTOR OF CLINICAL OPERATIONS
Credential: PHARMD
Phone: 870-836-1303