Healthcare Provider Details

I. General information

NPI: 1699139345
Provider Name (Legal Business Name): WASHINGTON REGIONAL MEDICAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3561 JOHNSON MILL BLVD SUITE 102
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

PO BOX 550
LOWELL AR
72745
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-4900
  • Fax: 479-463-4910
Mailing address:
  • Phone: 479-463-7775
  • Fax: 479-463-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN ECKELS
Title or Position: CFO
Credential:
Phone: 479-968-8279