Healthcare Provider Details

I. General information

NPI: 1427086313
Provider Name (Legal Business Name): BAXTER COUNTY REGIONAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

IV. Provider business mailing address

624 HOSPITAL DR
MOUNTAIN HOME AR
72653-2955
US

V. Phone/Fax

Practice location:
  • Phone: 870-508-1000
  • Fax: 870-508-1651
Mailing address:
  • Phone: 870-508-1000
  • Fax: 870-508-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberAR3827
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateAR

VIII. Authorized Official

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