Healthcare Provider Details

I. General information

NPI: 1336977172
Provider Name (Legal Business Name): BAXTER HEALTH FULTON COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 10/28/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 N MAIN STREET STE A
SALEM AR
72576
US

IV. Provider business mailing address

PO BOX 517
SALEM AR
72576-0517
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-4488
  • Fax:
Mailing address:
  • Phone: 870-895-2691
  • Fax: 870-895-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA HENRY
Title or Position: CFO
Credential:
Phone: 870-508-1003