Healthcare Provider Details

I. General information

NPI: 1619370558
Provider Name (Legal Business Name): HOWARD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CIR
NASHVILLE AR
71852-8606
US

IV. Provider business mailing address

130 MEDICAL CIR
NASHVILLE AR
71852-8606
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-8024
  • Fax: 870-845-8027
Mailing address:
  • Phone: 870-845-8024
  • Fax: 870-845-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG01544
License Number StateAR

VIII. Authorized Official

Name: JUDY KOSTERS
Title or Position: PFS DIRECTOR
Credential:
Phone: 870-845-8024