Healthcare Provider Details

I. General information

NPI: 1588618292
Provider Name (Legal Business Name): WASHINGTON REGIONAL MEDICAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 N NORTH HILLS BLVD
FAYETTEVILLE AR
72703
US

IV. Provider business mailing address

PO BOX 879
FAYETTEVILLE AR
72702-0879
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-4444
  • Fax: 479-463-4499
Mailing address:
  • Phone: 479-713-7115
  • Fax: 479-713-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY JO ROTHROCK
Title or Position: DIRECTOR CLINIC ADMINISTRATION
Credential:
Phone: 479-463-1390