Healthcare Provider Details

I. General information

NPI: 1851725139
Provider Name (Legal Business Name): BAXTER COUNTY REGIONAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 BURNETT DR
MOUNTAIN HOME AR
72653-2909
US

IV. Provider business mailing address

899 BURNETT DR
MOUNTAIN HOME AR
72653-2909
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-6212
  • Fax: 870-508-6896
Mailing address:
  • Phone: 870-425-6212
  • Fax: 870-508-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA HENRY
Title or Position: CFO
Credential:
Phone: 870-508-1003