Healthcare Provider Details

I. General information

NPI: 1780620534
Provider Name (Legal Business Name): CRITTENDEN HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NATHAN ST
MARKED TREE AR
72365-1447
US

IV. Provider business mailing address

105 NATHAN ST
MARKED TREE AR
72365-1447
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-2036
  • Fax: 870-358-4116
Mailing address:
  • Phone: 870-358-2036
  • Fax: 870-358-4116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAMONA TAYLOR
Title or Position: DIRECTOR OF DEVELOPMENT
Credential:
Phone: 870-735-5527