Healthcare Provider Details

I. General information

NPI: 1770580995
Provider Name (Legal Business Name): DREW COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 HIGHWAY 278 E
MONTICELLO AR
71655-7901
US

IV. Provider business mailing address

778 SCOGIN DR
MONTICELLO AR
71655-5729
US

V. Phone/Fax

Practice location:
  • Phone: 870-460-3585
  • Fax:
Mailing address:
  • Phone: 870-460-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberAR4466
License Number StateAR

VIII. Authorized Official

Name: MS. KARON BEAVERS
Title or Position: RN DIRECTOR
Credential: RN
Phone: 870-460-3585