Healthcare Provider Details

I. General information

NPI: 1215692330
Provider Name (Legal Business Name): BAXTER COUNTY REGIONAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MAIN ST STE 4
MAMMOTH SPRING AR
72554-7425
US

IV. Provider business mailing address

350 MAIN ST STE 4
MAMMOTH SPRING AR
72554-7425
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-3111
  • Fax:
Mailing address:
  • Phone: 870-625-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA HENRY
Title or Position: CFO
Credential:
Phone: 870-508-1003