Healthcare Provider Details

I. General information

NPI: 1275451817
Provider Name (Legal Business Name): GREAT RIVER MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
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

PO BOX 108
BLYTHEVILLE AR
72316-0108
US

V. Phone/Fax

Practice location:
  • Phone: 870-563-6504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LACEY CARTER
Title or Position: CEO
Credential:
Phone: 870-838-7460