Healthcare Provider Details

I. General information

NPI: 1831879824
Provider Name (Legal Business Name): BOSTON MOUNTAIN RURAL HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/04/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 4TH ST
QUITMAN AR
72131-9289
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 888-602-3647
  • Fax: 888-571-3256
Mailing address:
  • Phone: 870-448-5733
  • Fax: 870-448-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE ACKERSON
Title or Position: CEO
Credential:
Phone: 870-448-5733