Healthcare Provider Details

I. General information

NPI: 1619274792
Provider Name (Legal Business Name): CRITTENDEN HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N MISSOURI ST
WEST MEMPHIS AR
72301-3150
US

IV. Provider business mailing address

200 TYLER ST
WEST MEMPHIS AR
72301-2248
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-1500
  • Fax: 870-732-7711
Mailing address:
  • Phone: 870-735-1500
  • Fax: 870-732-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES R CARTER JR.
Title or Position: CEO
Credential:
Phone: 870-735-1500