Healthcare Provider Details

I. General information

NPI: 1508059791
Provider Name (Legal Business Name): ARKANSAS METHODIST HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W KINGSHIGHWAY
PARAGOULD AR
72450-5942
US

IV. Provider business mailing address

900 W KINGSHIGHWAY
PARAGOULD AR
72450-5942
US

V. Phone/Fax

Practice location:
  • Phone: 870-239-7000
  • Fax: 870-239-7325
Mailing address:
  • Phone: 870-239-7000
  • Fax: 870-239-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberAR4056
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberAR4056
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberAR4056
License Number StateAR

VIII. Authorized Official

Name: BRYAN G JACKSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 870-239-7000