Healthcare Provider Details

I. General information

NPI: 1982662136
Provider Name (Legal Business Name): SOUTHWEST ARKANSAS HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 EAST 13TH STREET
MURFREESBORO AR
71958-0000
US

IV. Provider business mailing address

PO BOX F
MURFREESBORO AR
71958-0000
US

V. Phone/Fax

Practice location:
  • Phone: 870-285-3182
  • Fax: 870-285-3305
Mailing address:
  • Phone: 870-285-3182
  • Fax: 870-285-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number82
License Number StateAR

VIII. Authorized Official

Name: MR. ROBERT R HICKS
Title or Position: CEO
Credential:
Phone: 870-285-3182