Healthcare Provider Details

I. General information

NPI: 1700842994
Provider Name (Legal Business Name): CRITTENDEN HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W TYLER AVE SUITE 105
WEST MEMPHIS AR
72301-4223
US

IV. Provider business mailing address

228 W TYLER AVE SUITE 105
WEST MEMPHIS AR
72301-4223
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-4025
  • Fax: 870-735-0570
Mailing address:
  • Phone: 870-735-4025
  • Fax: 870-735-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN8431
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM B MCCORMICK
Title or Position: CFO
Credential:
Phone: 870-735-1500