Healthcare Provider Details

I. General information

NPI: 1982615589
Provider Name (Legal Business Name): ST BERNARD COMMUNITY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 FALLS BLVD S
WYNNE AR
72396-3013
US

IV. Provider business mailing address

310 FALLS BLVD S
WYNNE AR
72396-3013
US

V. Phone/Fax

Practice location:
  • Phone: 870-238-3300
  • Fax: 870-238-7432
Mailing address:
  • Phone: 870-238-3300
  • Fax: 870-238-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberAR4063
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberAR4063
License Number StateAR

VIII. Authorized Official

Name: MR. BRYAN MATTES
Title or Position: ASSOCIATE ADMINISTRATOR
Credential:
Phone: 870-238-3300