Healthcare Provider Details

I. General information

NPI: 1376635953
Provider Name (Legal Business Name): LAWRENCE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 WEST MAIN ST
WALNUT RIDGE AR
72476-0839
US

IV. Provider business mailing address

PO BOX 839 1309 WEST MAIN ST
WALNUT RIDGE AR
72476-0839
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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BILL MAXWELL
Title or Position: BOARD - CHAIRMAN
Credential:
Phone: 870-878-6485