Healthcare Provider Details

I. General information

NPI: 1205940236
Provider Name (Legal Business Name): DARDANELLE REGIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH 3RD STREET
DARDANELLE AR
72834
US

IV. Provider business mailing address

200 NORTH 3RD STREET
DARDANELLE AR
72834
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-4677
  • Fax: 479-229-6162
Mailing address:
  • Phone: 479-229-4677
  • Fax: 479-229-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: BRANDY TALLEY
Title or Position: CONTROLLER
Credential:
Phone: 479-229-4677