Healthcare Provider Details

I. General information

NPI: 1366408973
Provider Name (Legal Business Name): WASHINGTON REGIONAL MEDICAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N NORTHHILLS BLVD WASHINGTON REGIONAL PSYCHIATRIC CLINIC
FAYETTEVILLE AR
72703-4424
US

IV. Provider business mailing address

12 E APPLEBY CLINIC ADMINISTRATION
FAYETTEVILLE AR
72703
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-2004
  • Fax: 479-463-7864
Mailing address:
  • Phone: 479-463-1704
  • Fax: 479-463-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN ECKELS
Title or Position: VICE PRESIDENT AND CFO
Credential:
Phone: 479-463-6026