Healthcare Provider Details

I. General information

NPI: 1295767689
Provider Name (Legal Business Name): DELTA MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HWY 65 SOUTH
DUMAS AR
71639
US

IV. Provider business mailing address

811 HWY 65 SOUTH
DUMAS AR
71639
US

V. Phone/Fax

Practice location:
  • Phone: 870-382-4303
  • Fax: 870-382-6555
Mailing address:
  • Phone: 870-382-4303
  • Fax: 870-382-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAR4296
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAR4392
License Number StateAR

VIII. Authorized Official

Name: CRIS BOLIN
Title or Position: CFO
Credential:
Phone: 870-382-8126