Healthcare Provider Details

I. General information

NPI: 1710962451
Provider Name (Legal Business Name): MCGEHEE DESHA COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 3RD ST
MC GEHEE AR
71654-2563
US

IV. Provider business mailing address

PO BOX 351
MC GEHEE AR
71654-0351
US

V. Phone/Fax

Practice location:
  • Phone: 870-222-3805
  • Fax: 870-222-3984
Mailing address:
  • Phone: 870-222-3805
  • Fax: 870-222-3984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR4067
License Number StateAR

VIII. Authorized Official

Name: MS. ANGIE SNOW
Title or Position: BILLING/STAFF NURSE
Credential: LPN
Phone: 870-222-3805