Healthcare Provider Details

I. General information

NPI: 1255429726
Provider Name (Legal Business Name): BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 VILLAGE VILLAGE PLACE
FAIRFIELD BAY AR
72088
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 501-884-6898
  • Fax: 501-884-6831
Mailing address:
  • Phone: 870-448-5101
  • Fax: 870-448-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. MELANIE CAMPBELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 870-448-5101