Healthcare Provider Details

I. General information

NPI: 1457567380
Provider Name (Legal Business Name): DARDANELLE COMMUNITY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH THIRD STREET
DARDANELLE AR
72834
US

IV. Provider business mailing address

PO BOX 578
DARDANELLE AR
72834-0578
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 TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number57673
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAR3750
License Number StateAR

VIII. Authorized Official

Name: SONDRA WEAR
Title or Position: CFO
Credential:
Phone: 479-229-4677