Healthcare Provider Details

I. General information

NPI: 1871128116
Provider Name (Legal Business Name): BAXTER COUNTY REGIONAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BUTTERCUP DR SUITE C
MOUNTAIN HOME AR
72653
US

IV. Provider business mailing address

310 BUTTERCUP DR SUITE C
MOUNTAIN HOME AR
72653
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-6977
  • Fax: 870-508-1615
Mailing address:
  • Phone: 870-508-6977
  • Fax: 870-508-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY SWALLOW
Title or Position: PHYSICIAN NETWORK MANAGER
Credential:
Phone: 870-508-6977