Healthcare Provider Details

I. General information

NPI: 1922183201
Provider Name (Legal Business Name): DREW MEMORIAL HOSPITAL PERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
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: 870-367-1154
  • Fax: 870-460-3534
Mailing address:
  • Phone: 870-367-1154
  • Fax: 870-460-3534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberAR3421
License Number StateAR

VIII. Authorized Official

Name: MS. KARON BEAVERS
Title or Position: DIRECTOR
Credential: RN
Phone: 870-367-2411