Healthcare Provider Details

I. General information

NPI: 1477004109
Provider Name (Legal Business Name): WASHINGTON REGIONAL MEDICAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S BLOOMINGTON ST
LOWELL AR
72745-9490
US

IV. Provider business mailing address

203 S BLOOMINGTON ST
LOWELL AR
72745-9490
US

V. Phone/Fax

Practice location:
  • Phone: 479-770-0728
  • Fax: 479-770-0712
Mailing address:
  • Phone: 479-770-0728
  • Fax: 479-770-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BRADLEY
Title or Position: CEO
Credential:
Phone: 479-463-1000