Healthcare Provider Details

I. General information

NPI: 1770509689
Provider Name (Legal Business Name): DELTA MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HWY 65 SOUTH
DUMAS AR
71639
US

IV. Provider business mailing address

PO BOX 887
DUMAS AR
71639-0887
US

V. Phone/Fax

Practice location:
  • Phone: 870-382-4303
  • Fax:
Mailing address:
  • Phone: 870-382-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberAR4296
License Number StateAR

VIII. Authorized Official

Name: SALLY MUNRO
Title or Position: PATIENT FINANCE DIRECTOR
Credential:
Phone: 870-382-8262