Healthcare Provider Details

I. General information

NPI: 1346784162
Provider Name (Legal Business Name): BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 HIGHWAY 65 NORTH
MARSHALL AR
72650-1060
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 870-448-5733
  • Fax:
Mailing address:
  • Phone: 870-448-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: BECKY BLAIR
Title or Position: CFO
Credential:
Phone: 870-448-5733