Healthcare Provider Details

I. General information

NPI: 1093810392
Provider Name (Legal Business Name): MENA HOSPITAL COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N MORROW
MENA AR
71953-2516
US

IV. Provider business mailing address

311 N MORROW
MENA AR
71953-2516
US

V. Phone/Fax

Practice location:
  • Phone: 479-394-6100
  • Fax: 479-394-4577
Mailing address:
  • Phone: 479-394-6100
  • Fax: 479-394-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberAR4321
License Number StateAR

VIII. Authorized Official

Name: GAYLA CROWLEY
Title or Position: DIRECTOR REVENUE CYLCE
Credential:
Phone: 479-243-2239