Healthcare Provider Details

I. General information

NPI: 1073129755
Provider Name (Legal Business Name): MISSISSIPPI COUNTY HOSPITAL SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W UNION AVE STE B
OSCEOLA AR
72370-3022
US

IV. Provider business mailing address

1520 N DIVISION ST
BLYTHEVILLE AR
72315-1448
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-6504
  • Fax: 870-622-0611
Mailing address:
  • Phone: 870-838-7462
  • Fax: 870-838-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRIS LEE RAYMER
Title or Position: CEO
Credential:
Phone: 870-838-7463