Healthcare Provider Details

I. General information

NPI: 1174857825
Provider Name (Legal Business Name): BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 WEST MAIN ST
GREEN FOREST AR
72638-2810
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 870-438-6500
  • Fax: 870-438-6615
Mailing address:
  • Phone: 870-448-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEBBIE ACKERSON
Title or Position: CEO
Credential:
Phone: 870-448-5733