Healthcare Provider Details

I. General information

NPI: 1316955891
Provider Name (Legal Business Name): STUTTGART REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N BUERKLE ST
STUTTGART AR
72160-3153
US

IV. Provider business mailing address

PO BOX 1905
STUTTGART AR
72160-1905
US

V. Phone/Fax

Practice location:
  • Phone: 870-674-6402
  • Fax: 870-672-6888
Mailing address:
  • Phone: 870-674-6402
  • Fax: 870-672-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN NEAL
Title or Position: CEO OF STUTTGART REGIONAL MEDICAL C
Credential:
Phone: 870-674-6402