Healthcare Provider Details

I. General information

NPI: 1285641258
Provider Name (Legal Business Name): DREW COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 SCOGIN DR
MONTICELLO AR
71655-5729
US

IV. Provider business mailing address

778 SCOGIN DR
MONTICELLO AR
71655-5729
US

V. Phone/Fax

Practice location:
  • Phone: 870-367-2411
  • Fax:
Mailing address:
  • Phone: 870-367-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number07012884001
License Number StateAR

VIII. Authorized Official

Name: VONDA K RUSSELL
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 870-460-3514