Healthcare Provider Details

I. General information

NPI: 1457720658
Provider Name (Legal Business Name): LAWRENCE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 W MAIN ST
WALNUT RIDGE AR
72476-1430
US

IV. Provider business mailing address

1309 W MAIN ST PO BOX 839
WALNUT RIDGE AR
72476-1430
US

V. Phone/Fax

Practice location:
  • Phone: 870-886-1200
  • Fax: 870-886-5340
Mailing address:
  • Phone: 870-886-1200
  • Fax: 870-886-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAR3842
License Number StateAR

VIII. Authorized Official

Name: MRS. VANESSA K WAGNER
Title or Position: CFO
Credential:
Phone: 870-886-1263