Healthcare Provider Details

I. General information

NPI: 1699731208
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: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 E APPLEBY RD WASHINGTON REGIONAL SENIOR CLINIC
FAYETTEVILLE AR
72703-3901
US

IV. Provider business mailing address

12 E APPLEBY RD CLINIC ADMINISTRATION
FAYETTEVILLE AR
72703-3901
US

V. Phone/Fax

Practice location:
  • Phone: 479-463-4444
  • Fax: 479-463-4499
Mailing address:
  • Phone: 479-463-1704
  • Fax: 479-463-7864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL R ECKELS
Title or Position: SENIOR VICE PRESIDENT/CFO
Credential:
Phone: 479-463-6026