Healthcare Provider Details

I. General information

NPI: 1114031143
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: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 3RD ST
DARDANELLE AR
72834-3802
US

IV. Provider business mailing address

200 N 3RD ST
DARDANELLE AR
72834-3802
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 Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

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